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Working together on gut stasis

09 April 2019, at 9:30am

The management of gut stasis in rabbits often requires prompt intervention and the support of an RVN

Gut stasis is one of the most serious conditions a rabbit could have, and it deserves to be taken seriously by both the owner and veterinary staff. Because there are many possible causes (many of them external to the gut itself), it must be highlighted that it is a symptom and not a final diagnosis. A rabbit that presents in gut stasis requires a full clinical examination and husbandry review. At this stage, the cause of the gut stasis may become obvious.

Be aware that a rabbit that has been eating poorly for a while and finally stopped may well have acquired dental disease; however, this may not be the only cause of it stopping eating. Other causes such as bladder sludging, renal disease or even liver lobe torsion should still be investigated, depending on other clinical signs and the results of the physical examination.

The authors’ preference is to see rabbits that have stopped eating within 12 hours. Prompt examination and comprehensive treatment allow stabilisation of the patient and enable an immediate improvement to its welfare. In addition, early treatment facilitates getting the patient stable enough to undergo diagnostic testing to determine the underlying cause. In the longer term, treatment of gut stasis alone is insufficient, and a diagnosis of the underlying cause will allow prevention of further episodes of gut stasis, or at least better long-term control.

Gut blockages, while causing gut stasis, are not always directly part of the gut stasis syndrome we regularly see. Blockages are often secondary to the rabbit eating some-thing inappropriate, for example, nuts, fake straw bedding, wallpaper or cardboard. Occasionally, over-grooming (either of itself or its companion) can lead to blockage with fur.

In some cases, gastrointestinal blockage can be due to internal disease (such as a mass within or adjacent to the gut that affects lumen diameter). In some cases where there is gas build-up in the stomach, the pressure and size of the stomach cause the gastric outflow to block, causing obstruction. Any potential gut blockage is an emergency situation – these rabbits need to be seen as soon as possible as treatment for gastrointestinal blockage often requires surgery.

The rabbit is dependent on the efficient functioning of its gut to be able to obtain energy and nutrients from a relatively poor diet. The gut volume is large compared to the body size, and the caecum acts as a fermentation vat that allows the smaller particles from the diet to undergo bacterial digestion. This means that if the gut is distended or painful, then there is a significant impact on the rabbit in terms of ability to adequately digest food. As soon as the gut motility is reduced, the composition of the bacteria in the caecum rapidly changes, meaning that the ability to digest food is altered.

FIGURE (1) X-ray showing gas in the caecum
FIGURE (1) X-ray showing gas in the caecum
FIGURE (2) Gas throughout the gut
FIGURE (2) Gas throughout the gut
FIGURE (3) Gas cap in the stomach
FIGURE (3) Gas cap in the stomach

Often, when the gut is not normally motile, food matter that would ordinarily be sent to the caecum for additional fermentation is lost as diarrhoea. Therefore, when the gut is not moving normally, the rabbit patient can very rapidly experience significant shifting of fluid into the gut, electrolyte changes (calcium, sodium, potassium and chloride are all electrolyte molecules that can be affected by gut stasis) and negative energy balance (because little energy is being extracted from what little food is being taken in).

Where an obstruction is suspected, it is useful to check a blood glucose level. Rabbits that have very high blood glucose when in gut stasis are more likely to have a gut obstruction, although this is not diagnostic. If the blood glucose is high, then X-rays (Figures 1 to 3) or ultrasound should be used to further rule in or out an obstruction.

In most cases, however, where there is no evidence of a blockage, analgesia, prokinetics, fluid therapy and supported feeding are appropriate. Most rabbits are less stressed and more likely to eat voluntarily at home, although this depends on owner compliance. If a rabbit on treatment has not started eating within 24 hours, or if it is getting worse, becoming more lethargic or is painful, than a repeat examination is needed. A failure to improve with medications may be a sign that there is something going on that hasn’t yet been identified and addressed.

A rabbit diagnosed with a gut blockage usually requires surgical intervention or euthanasia. The reality is that this condition will worsen rapidly with very little potential for it to correct itself without intervention. This means that the animal in question is likely to suffer significantly. Gut surgery, particularly if the rabbit has not been eating for a couple of days, carries a significant risk. Gut stasis medications (the prokinetics) are contraindicated where there is a gut blockage, as they can lead to rupture of the gut. With stabilisation, fluids, good pain relief and good nursing care, rabbits with gut blockages can survive and go on to thrive, so surgery is definitely worth considering.

Gut stasis is a potentially serious condition; however, with appropriate interventions and particularly nursing support and feedback, good outcomes can be achieved.

References
Author Year Title
Harcourt-Brown, F. 2016 Gastrointestinal diseases. In: Meredith, A. and Lord, B. BSAVA Manual of Rabbit Medicine, BSAVA
Velasco-Galilea, M., Piles, M., Viñas, M., Rafel, O., González-Rodríguez, O., Guivernau, M. and Sánchez, J. P. 2018 Rabbit microbiota changes throughout the intestinal tract. Frontiers in Microbiology, 9, 2144.
Deflers, H., Gandar, F., Bolen, G., Farnir, F. and Marlier, D. 2018 Influence of a single dose of buprenorphine on rabbit (Oryctolagus cuniculi) gastro-intestinal motility. Veterinary Anaesthesia and Analgesia, 45, 510-519.
Green, H. 2017 Factors contributing to fatalities in hospitalised rabbits. The Veterinary Nurse

Molly Varga, BVetMed, DZooMed, MRCVS, graduated from the RVC in 1992. She has a Certificate in Zoological Medicine, a Diploma in Zoological Medicine (Mammalian) and is an RCVS Recognised Specialist in Zoo and Wildlife Medicine. She currently runs a first opinion and referral exotics service.

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Jo Hinde, RVN, is an award-winning veterinary nurse with a special interest in rabbits. She has worked in the veterinary profession since 2007 and now runs LagoLearn, providing rabbit-specific training in the UK and internationally. Jo is currently the Junior Vice President of the BVNA.

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