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Physical examination and clinical techniques

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Abstract

Rabbit medicine is a rapidly evolving field and owners increasingly expect a high standard of veterinary care for their pets. Veterinary surgeons must be confident in handling, restraint and clinical examination. Clinical examination of the rabbit has important differences compared with other species and this chapter outlines the common clinical procedures and variations, history taking, safe handling, physical examination and diagnostic techniques. An example rabbit history form is included.

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Figures

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7.1 Rabbits may be brought to the clinic in a variety of carriers.
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7.3 Rabbits can be lifted by sliding one hand under the rump and supporting the thorax with the other hand. Once lifted, the rabbit is cradled into the handler’s body for security. Again using one hand to support the rump and the other to support the thorax, the rabbit is held with the head tucked into the crook of the elbow of the handler.
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7.4 The correct method of restraint for examination of the ventral area with the help of an assistant.
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7.5 The ‘bunny burrito’. An appropriately sized towel should be placed unfolded on the table with the rabbit on top. Do not use too small a towel or the folds will loosen. One side of the towel is wrapped over the dorsum and ‘tucked in’ under the ventrum of the opposite side. The towel at the rump area is folded forwards over the lumbar spine region. The remaining towel end is folded over the dorsum, tucking in the front feet, before being secured under the ventral area of the opposite side. Only the head of the rabbit is visible, which can facilitate examination of the head and also administration of medication.
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7.6 Two-person restraint in lateral recumbency.
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7.8 The position of the central auricular artery, which can be used for pulse palpation, is shown here by transillumination.
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7.9 Using a paediatric stethoscope to auscultate gut sounds.
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7.10 This rabbit had a chronic ocular discharge with involvement of the nasolacrimal duct, conjunctivitis and severe blepharitis.
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7.11 The slit-shaped opening of the nasolacrimal duct can be seen clearly in the majority of rabbits.
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7.12 With gentle pressure, the occlusal surfaces of the cheek teeth should allow smooth lateral movement from one side to the other. If ‘sticking’ of teeth is noted, this can be a sign of abnormalities of the premolars and molars.
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7.14 This obese rabbit had been fed pellets . It was given a body condition score (BCS) of 5/5.
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7.15 Abdominal palpation. Elevating the thorax allows structures in the cranial abdomen to be better appreciated.
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7.16 ‘Dirty hankies’. The medial aspects of the front legs are often used by the rabbit to wipe nasal, oral and ocular discharges and are referred to as ‘hankies’ in the rabbit world.
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7.17 This rabbit is at high risk of fly strike.
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7.18 Male genitalia. In older rabbits the testicles and penis are readily identifiable.
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7.19 Female genitalia. The vulva is slit-like.
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7.20 The point of the hock is the most common location for pododermatitis.
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7.21 For dental examination, the rabbit should be held on a non-slip surface with the rump resting against the abdomen of the holder. The handler supports the thoracic area, using their thumbs to apply gentle downwards pressure.
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7.22 A rabbit anaesthetized and restrained using a dental frame to aid oral examination.
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7.23 Otoscopic examination of the mouth is extremely useful and an important part of every examination. Care should be taken when holding the rabbit’s head not to occlude the nostrils.
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7.26 Blood sampling from the jugular vein. Correct restraint. With the neck extended, the jugular vein is easily located lying in the jugular groove lateral to the trachea.
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7.27 Blood sampling from the lateral saphenous vein. Restraint in lateral recumbency. Restraint in sternal recumbency with the hindlimb suspended over the edge of the table. The lateral saphenous vein is best located just above the hock joint, running over the lateral surface of the distal tibia.
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7.28 Blood sampling from the cephalic vein. Correct restraint. Once raised, the cephalic vein is easily visible on the cranial forelimb.
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7.30 Does are easily catheterized if positioned correctly. Anatomy of the female rabbit urogenital tract to show the position of the urethra, ventral to the vagina. The urinary catheter should be directed ventrally along the floor of the vagina and into the urethral ostium for correct placement. (Reproduced from the ). Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and printed with her permission.
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7.31 An Elizabethan collar can be used to prevent caecotrophy if collection is required.
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7.32 Bone marrow sampling. Holding the stifle, the thumb is moved along the femur until it reaches the fossa between the greater and lesser trochanters of the femur. The needle is then inserted under the thumb into the bone, directed towards the long axis of the bone. Suction pressure loosens the marrow particles, which are aspirated into the syringe. See text for more details.
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7.33 Collection of CSF from the cisterna magna. An area extending caudally from the occipital protuberance to the third cervical vertebra and laterally just beyond the wings of atlas is prepared. Needle placement is in the dorsal midline just cranial to the cranial margins of the wings of atlas. When the stylet is removed CSF gathers in the hub of the needle and drips into a plastic container. See text for more details.
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7.34 Needle placement for collection of CSF from the lumbosacral space (shown here on a cadaver). See text for more details.
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7.35 Deep nasal swab sampling. Pre-measuring the swab. The swab is slowly advanced ventromedially. See text for more details.
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7.36 Bronchoalveolar lavage. Warm sterile saline is flushed down the catheter using a sterile syringe; approximately half the total fluid volume used should be aspirated back. See text for more details. (© Elisabetta Mancinelli)
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7.38 Positioning and restraint for intramuscular injection.
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7.39 Placement of an intravenous catheter; see text for details.
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7.40 Intravenous fluid therapy via an ear vein. A rabbit receiving a bolus of fluids to the lateral saphenous vein, with the hind foot being held.
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7.41 Necrosis of the marginal ear vein following long-term intravenous fluid therapy.
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7.42 Intraosseous catheterization.
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7.43 Intraosseous catheter in place in the proximal femur. Administration of fluids or medication by slow continuous infusion through an intraosseous catheter.
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7.44 Rabbit in an incubator adapted for nebulization treatment.
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7.45 Critical care syringe-feeding.
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7.46 Nasogastric tube in place. (© Joanna Hedley)
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7.47 Pre-measurement of an orogastric tube prior to placement.
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7.48 Nasolacrimal cannulation.

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An example of a rabbit history form.

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