Digestive system disease

Frances Harcourt-Brown

doi:10.22233/9781910443217.12

British Small Animal Veterinary Association , 168 (2014); https://doi.org/10.22233/9781910443217.12

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Digestive system disease

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Author: Frances Harcourt-Brown
From: BSAVA Manual of Rabbit Medicine
Item: Chapter 12, pp 168 - 190
DOI: 10.22233/9781910443217.12
Copyright: © 2014 British Small Animal Veterinary Association
Publication Date: February 2014

Abstract

Many diseases can affect the digestive system of rabbits. This chapter explores the signs of digestive disease and the common digestive disorders including regurgitation and oesophageal disease, diseases of the stomach, gastrointestinal hypomotility, small intestinal obstruction, diarrhoea, enteric disease, and others.

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Figures

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12.1

Normal appearance of the caecum and proximal colon. Abdominal contents of a juvenile male wild rabbit that was killed by a car, showing the size of the caecum and proximal colon, which were full of ingesta. The rabbit was killed in the morning and had just filled its digestive tract with food. The size of the caecum gives an idea of the amount of caecotrophs that are expelled and consumed each day. © 2014 British Small Animal Veterinary Association

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12.1 Normal appearance of the caecum and proximal colon. Abdominal contents of a juvenile male wild rabbit that was killed by a car, showing the size of the caecum and proximal colon, which were full of ingesta. The rabbit was killed in the morning and had just filled its digestive tract with food. The size of the caecum gives an idea of the amount of caecotrophs that are expelled and consumed each day.

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12.3

Faecal pellets that were passed by a 3-year-old Lionhead neutered female. Rabbits ingest a lot of fur, especially during moulting. The fur passes through the digestive tract and is compressed into hard faecal pellets, which may be joined by long strands of hair in long-haired breeds. © 2014 British Small Animal Veterinary Association

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12.3 Faecal pellets that were passed by a 3-year-old Lionhead neutered female. Rabbits ingest a lot of fur, especially during moulting. The fur passes through the digestive tract and is compressed into hard faecal pellets, which may be joined by long strands of hair in long-haired breeds.

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12.4

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12.4 Gross appearance of faeces.

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12.5

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12.5 Significance of faecal output.

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12.6

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12.6 Microscopic examination of faeces. Please note that magnification varies in the images.

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12.8

This 4-year-old neutered female rabbit suddenly stopped eating and started to make choking noises as she was eating nuggets. Green fluid came out of her nose and mouth. She was dyspnoeic. Anaesthesia was induced with intravenous propofol and maintained by continuous infusion while a tube was passed down her oesophagus into her stomach. Some resistance was felt and the respiratory noise and fluid regurgitation stopped. Subsequent endoscopic examination of the oesophagus showed no obstruction or abnormality apart from green liquid. The rabbit recovered uneventfully. A presumed diagnosis of oesophageal obstruction by nuggets of food was made. The rabbit was known to eat greedily. © 2014 British Small Animal Veterinary Association

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12.8 This 4-year-old neutered female rabbit suddenly stopped eating and started to make choking noises as she was eating nuggets. Green fluid came out of her nose and mouth. She was dyspnoeic. Anaesthesia was induced with intravenous propofol and maintained by continuous infusion while a tube was passed down her oesophagus into her stomach. Some resistance was felt and the respiratory noise and fluid regurgitation stopped. Subsequent endoscopic examination of the oesophagus showed no obstruction or abnormality apart from green liquid. The rabbit recovered uneventfully. A presumed diagnosis of oesophageal obstruction by nuggets of food was made. The rabbit was known to eat greedily.

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12.9

Lateral abdominal radiograph of a 3-year-old neutered male Dwarf Lop that had chewed a cushion. One end of a piece of the kapok stuffing had caught around a curved elongated tooth and the remaining section, which was 4 cm long, was lodged in the oesophagus. The rabbit was not eating but was bright and active. The radiograph shows that there is little or no food in the gastrointestinal tract, but it is filled with air instead. The stomach is not enlarged. It is contained within the costal arch and does not meet the ventral abdominal floor. The rabbit recovered after the piece of kapok was removed. © 2014 British Small Animal Veterinary Association

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12.9 Lateral abdominal radiograph of a 3-year-old neutered male Dwarf Lop that had chewed a cushion. One end of a piece of the kapok stuffing had caught around a curved elongated tooth and the remaining section, which was 4 cm long, was lodged in the oesophagus. The rabbit was not eating but was bright and active. The radiograph shows that there is little or no food in the gastrointestinal tract, but it is filled with air instead. The stomach is not enlarged. It is contained within the costal arch and does not meet the ventral abdominal floor. The rabbit recovered after the piece of kapok was removed.

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12.10

Immediate post-mortem appearance of a rabbit that had not eaten for 2–3 days, with presumed gut stasis. There was a perforated gastric ulcer with food in the abdominal cavity, a fatty liver but no other obvious abnormality. The referring practitioner had prescribed a high dose (1.5 mg/kg) of meloxicam in the preceding days and it is not known whether this was a contributory factor to the gastric ulceration. © 2014 British Small Animal Veterinary Association

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12.10 Immediate post-mortem appearance of a rabbit that had not eaten for 2–3 days, with presumed gut stasis. There was a perforated gastric ulcer with food in the abdominal cavity, a fatty liver but no other obvious abnormality. The referring practitioner had prescribed a high dose (1.5 mg/kg) of meloxicam in the preceding days and it is not known whether this was a contributory factor to the gastric ulceration.

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12.11

This 4-year-old male neutered Angora rabbit presented unresponsive 3 hours after the sudden onset of anorexia. A dilated stomach was palpated in the cranial abdomen and a blood sample showed a high blood glucose level (19.6 mmol/l). The radiograph shows a dilated stomach filled with fluid and dilated gas-filled sections of small intestine. The stomach is in contact with the ventral abdominal floor. The hyperglycaemia and clinical signs are typical of an obstruction of the small intestine. © 2014 British Small Animal Veterinary Association

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12.11 This 4-year-old male neutered Angora rabbit presented unresponsive 3 hours after the sudden onset of anorexia. A dilated stomach was palpated in the cranial abdomen and a blood sample showed a high blood glucose level (19.6 mmol/l). The radiograph shows a dilated stomach filled with fluid and dilated gas-filled sections of small intestine. The stomach is in contact with the ventral abdominal floor. The hyperglycaemia and clinical signs are typical of an obstruction of the small intestine.

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12.12

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12.12 Appearance of the stomach of a rabbit with severe gastric dilation and tympany. The mucosa is inflamed and haemorrhagic.

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12.13

Radiographic appearance of the stomach in a rabbit with gastric impaction and caecal tympany due to advanced gut stasis. The stomach is small and contracted and contains a ball of ingesta surrounded by a halo of gas. There is a considerable amount of gas in the ileocaecocolic complex. The rabbit died and hepatic lipidosis was confirmed during post-mortem examination. A dental spur was the inciting cause. © 2014 British Small Animal Veterinary Association

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12.13 Radiographic appearance of the stomach in a rabbit with gastric impaction and caecal tympany due to advanced gut stasis. The stomach is small and contracted and contains a ball of ingesta surrounded by a halo of gas. There is a considerable amount of gas in the ileocaecocolic complex. The rabbit died and hepatic lipidosis was confirmed during post-mortem examination. A dental spur was the inciting cause.

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12.14

The liver of a rabbit that died from hepatic lipidosis. The rabbit had undergone coronal reduction 3 days previously after a molar spur was detected. The rabbit did not start to eat after discharge so the owners sought a second opinion. The rabbit died despite treatment, and post-mortem examination confirmed the presence of a pale, fatty, friable liver. © 2014 British Small Animal Veterinary Association

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12.14 The liver of a rabbit that died from hepatic lipidosis. The rabbit had undergone coronal reduction 3 days previously after a molar spur was detected. The rabbit did not start to eat after discharge so the owners sought a second opinion. The rabbit died despite treatment, and post-mortem examination confirmed the presence of a pale, fatty, friable liver.

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12.15

Intestinal foreign body in a section of small intestine that was exteriorized during surgery. The foreign body was obstructing the lumen. The section of intestine that is proximal to the obstruction is distended with gas and fluid in contrast to the distal section. In this case, the foreign body was successfully milked through the small intestine and through the ileocolic valve, which released the gas and fluid into the hindgut. The rabbit recovered. © 2014 British Small Animal Veterinary Association

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12.15 Intestinal foreign body in a section of small intestine that was exteriorized during surgery. The foreign body was obstructing the lumen. The section of intestine that is proximal to the obstruction is distended with gas and fluid in contrast to the distal section. In this case, the foreign body was successfully milked through the small intestine and through the ileocolic valve, which released the gas and fluid into the hindgut. The rabbit recovered.

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12.16

Intestinal hypertrophy. (a) A section of small intestine from a rabbit that was suffering from intermittent bouts of anorexia and colic that were becoming more frequent and severe. Exploratory surgery was performed when gastric dilation developed. A section of hypertrophied mucosa (b) was causing a partial obstruction. Histopathology confirmed that it was not neoplastic. The author has seen several similar cases but the aetiology is unknown. © 2014 British Small Animal Veterinary Association

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12.16 Intestinal hypertrophy. (a) A section of small intestine from a rabbit that was suffering from intermittent bouts of anorexia and colic that were becoming more frequent and severe. Exploratory surgery was performed when gastric dilation developed. A section of hypertrophied mucosa (b) was causing a partial obstruction. Histopathology confirmed that it was not neoplastic. The author has seen several similar cases but the aetiology is unknown.

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12.17

A section of the small intestine of a 2-year-old male neutered rabbit that showed signs of intermittent colic, gastric distension and anorexia. Part of the intestine followed an anomalous path, forming a U-bend that could obstruct the flow of ingesta. The anomaly was discovered during exploratory laparotomy and was corrected by carefully sectioning a narrow part of the mesentery within the U-bend and repairing it so the intestine followed a straight path. The rabbit recovered from surgery and survived for at least 3 years without signs of colic. © 2014 British Small Animal Veterinary Association

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12.17 A section of the small intestine of a 2-year-old male neutered rabbit that showed signs of intermittent colic, gastric distension and anorexia. Part of the intestine followed an anomalous path, forming a U-bend that could obstruct the flow of ingesta. The anomaly was discovered during exploratory laparotomy and was corrected by carefully sectioning a narrow part of the mesentery within the U-bend and repairing it so the intestine followed a straight path. The rabbit recovered from surgery and survived for at least 3 years without signs of colic.

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12.18

Radiograph of the rabbit in Figure 12.11 , taken 1 hour later. The rabbit had been given fentanyl/fluanisone (0.2 ml/kg) in the interim. The radiograph shows that the stomach is still dilated but less so than in Figure 12.11 , and the intestinal gas has moved into the ileocaecocolic complex. This was interpreted as a good prognostic sign, indicating that the obstruction had moved into the hindgut. The blood glucose had fallen to 14.6 mmol/l. The rabbit started to eat 1 hour later. © 2014 British Small Animal Veterinary Association

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12.18 Radiograph of the rabbit in Figure 12.11 , taken 1 hour later. The rabbit had been given fentanyl/fluanisone (0.2 ml/kg) in the interim. The radiograph shows that the stomach is still dilated but less so than in Figure 12.11 , and the intestinal gas has moved into the ileocaecocolic complex. This was interpreted as a good prognostic sign, indicating that the obstruction had moved into the hindgut. The blood glucose had fallen to 14.6 mmol/l. The rabbit started to eat 1 hour later.

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12.21

Typical appearance of a juvenile rabbit that could have been suffering from any one (or a combination) of the range of digestive disorders that can affect young rabbits. He was thin but there was abdominal distension. His coat was staring and he was inappetent. He was passing loose faeces which contained coccidial oocysts. The radiograph and subsequent post-mortem examination showed typical signs of mucoid enteropathy. © 2014 British Small Animal Veterinary Association

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12.21 Typical appearance of a juvenile rabbit that could have been suffering from any one (or a combination) of the range of digestive disorders that can affect young rabbits. He was thin but there was abdominal distension. His coat was staring and he was inappetent. He was passing loose faeces which contained coccidial oocysts. The radiograph and subsequent post-mortem examination showed typical signs of mucoid enteropathy.

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12.24

Caecum of a 4-year-old male neutered Netherland Dwarf that died after developing acute haemorrhagic diarrhoea. The liquid haemorrhagic caecal contents can be seen through the caecal wall. Parts of the serosal surface of the caecum look as if they have been brushed with red paint (arrow). This is typical of enterotoxaemia. © 2014 British Small Animal Veterinary Association

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12.24 Caecum of a 4-year-old male neutered Netherland Dwarf that died after developing acute haemorrhagic diarrhoea. The liquid haemorrhagic caecal contents can be seen through the caecal wall. Parts of the serosal surface of the caecum look as if they have been brushed with red paint (arrow). This is typical of enterotoxaemia.

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12.26

Lateral radiograph of the abdomen of a mature neutered female spotted rabbit that was thin with a distended abdomen. Large pieces of impacted ingesta surrounded by gas can be seen in the caecum. The rabbit was eating a little but not passing faecal pellets. Blood urea and calcium were raised. The rabbit was euthanased and samples sent for histopathology. Chronic interstitial granulomatous inflammatory lesions consistent with encephalitozoonosis were found in the kidney. It is not known why the caecal impaction occurred. It could have been part of a megacolon syndrome, or linked with chronic dehydration and kidney disease, or due to another disorder. Kyphosis affecting the thoracic vertebrae was believed to be an incidental finding. © 2014 British Small Animal Veterinary Association

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12.26 Lateral radiograph of the abdomen of a mature neutered female spotted rabbit that was thin with a distended abdomen. Large pieces of impacted ingesta surrounded by gas can be seen in the caecum. The rabbit was eating a little but not passing faecal pellets. Blood urea and calcium were raised. The rabbit was euthanased and samples sent for histopathology. Chronic interstitial granulomatous inflammatory lesions consistent with encephalitozoonosis were found in the kidney. It is not known why the caecal impaction occurred. It could have been part of a megacolon syndrome, or linked with chronic dehydration and kidney disease, or due to another disorder. Kyphosis affecting the thoracic vertebrae was believed to be an incidental finding.

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12.27

Heavy metal poisoning. (a) Lateral view of the abdomen of a 6-year-old neutered female rabbit that lived in an old house and had chewed the skirting boards. The rabbit was referred for specialist treatment because of anorexia that had not responded to prokinetic, analgesic and intravenous fluid therapy. Speckles of radiodense material can be seen throughout the digestive tract. (b) White flakes appeared in the faeces once the rabbit started to defecate after syringe-feeding and treatment with penicillamine and prokinetics. This is a good example of the benefits of taking abdominal radiographs of anorexic rabbits. © 2014 British Small Animal Veterinary Association

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12.27 Heavy metal poisoning. (a) Lateral view of the abdomen of a 6-year-old neutered female rabbit that lived in an old house and had chewed the skirting boards. The rabbit was referred for specialist treatment because of anorexia that had not responded to prokinetic, analgesic and intravenous fluid therapy. Speckles of radiodense material can be seen throughout the digestive tract. (b) White flakes appeared in the faeces once the rabbit started to defecate after syringe-feeding and treatment with penicillamine and prokinetics. This is a good example of the benefits of taking abdominal radiographs of anorexic rabbits.

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12.28

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12.28 This rescue rabbit shows many typical signs of megacolon syndrome. He is a spotted breed, thin with a distended abdomen and ravenously hungry.

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12.29

Lateral view of the abdomen of a 5-year-old English Spot neutered male showing some of the typical signs of megacolon syndrome. The caecum is dilated and filled with gas (the radiograph was taken during an intermittent bout of anorexia) and there are some very large faecal pellets in the rectum (arrow). © 2014 British Small Animal Veterinary Association

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12.29 Lateral view of the abdomen of a 5-year-old English Spot neutered male showing some of the typical signs of megacolon syndrome. The caecum is dilated and filled with gas (the radiograph was taken during an intermittent bout of anorexia) and there are some very large faecal pellets in the rectum (arrow).

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12.30

Post-mortem appearance of the sacculus rotundus (a) and appendix (b) of a rabbit with Yersinia pseudotuberculosis infection. Both organs have a pale spotted appearance. The clinical signs were non-specific: the rabbit was anorexic and losing weight despite a range of treatments including enrofloxacin. Blood sample results showed lymphopenia, mild anaemia and slightly raised alkaline phosphatase. An abdominal mass was thought to be present, so exploratory laparotomy was performed. The mass proved to be the sacculus rotundus. © 2014 British Small Animal Veterinary Association

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12.30 Post-mortem appearance of the sacculus rotundus (a) and appendix (b) of a rabbit with Yersinia pseudotuberculosis infection. Both organs have a pale spotted appearance. The clinical signs were non-specific: the rabbit was anorexic and losing weight despite a range of treatments including enrofloxacin. Blood sample results showed lymphopenia, mild anaemia and slightly raised alkaline phosphatase. An abdominal mass was thought to be present, so exploratory laparotomy was performed. The mass proved to be the sacculus rotundus.

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12.31

Caecum of a rabbit with multicentric lymphoma. The kidneys were also affected. The tumour was discovered during exploratory surgery for chronic inappetence, weight loss and the suspicion of an abdominal mass. © 2014 British Small Animal Veterinary Association

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12.31 Caecum of a rabbit with multicentric lymphoma. The kidneys were also affected. The tumour was discovered during exploratory surgery for chronic inappetence, weight loss and the suspicion of an abdominal mass.

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12.32

Section of the distal colon of a rabbit with intermittent bouts of colic and anorexia. Palpable masses were present in the abdomen. On exploratory laparotomy, these masses proved to be evaginations of the intestinal mucosa containing ingesta. Two of these had formed abscesses, one of which is shown. The rabbit was euthanased. © 2014 British Small Animal Veterinary Association

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12.32 Section of the distal colon of a rabbit with intermittent bouts of colic and anorexia. Palpable masses were present in the abdomen. On exploratory laparotomy, these masses proved to be evaginations of the intestinal mucosa containing ingesta. Two of these had formed abscesses, one of which is shown. The rabbit was euthanased.

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12.33

(a) Part of a Cittotaenia tapeworm that was passed out after the rabbit had been treated with praziquantel (20 mg in 0.5 ml spot-on solution) because segments had been seen in the faeces. (b) Several Cittotaenia species can affect rabbits, but the condition is rare in pets. Eggs are shown in Figure 12.6 . © 2014 British Small Animal Veterinary Association

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12.33 (a) Part of a Cittotaenia tapeworm that was passed out after the rabbit had been treated with praziquantel (20 mg in 0.5 ml spot-on solution) because segments had been seen in the faeces. (b) Several Cittotaenia species can affect rabbits, but the condition is rare in pets. Eggs are shown in Figure 12.6 .

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12.34

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12.34 A Passalurus ambiguus pinworm in a hard faecal pellet from an adult pet rabbit. Eggs are shown in Figure 12.6 .

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12.35

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12.35 This overweight neutered female Dwarf Lop had a bleeding mass protruding from the anus. The mass was surgically removed.