[…] interventions. On top of a full clinical history and physical examination, complete bloodwork, urinalysis and abdominal radiography are considered baseline diagnostic investigations in RGIS. Clinical findings including hypothermia, hypotension, anemia, hyperglycemia, hepatic enzyme elevation, BUN elevation, acidosis, and a dilated stomach with a gas cap should alert the clinician to potentially life-threatening diseases, such as intestinal obstruction and liver lobe torsion. These conditions can be further defined using abdominal imaging studies, including serial radiographic studies, ultrasonography and/or contrast-enhanced computed tomography. Treatment is dependent on the underlying etiology. Fluid therapy and analgesia are considered cornerstones in the management of gastrointestinal disease in rabbits, but other specific treatments such as active warming, intestinal promotility agents, anti-microbials, and nutritional support may also be warranted. Surgery may indicated for some conditions, such as intestinal obstruction, liver lobe torsion, and appendicitis. Outline Overview of rabbit gastrointestinal anatomy and physiology Hindgut adaptations “Wash-back” colonic separation Cecotrophy Intestinal motility Rabbit gastrointestinal syndrome Definition Encompassed conditions Possible sequelae Diagnosis Relevant clinical history Clinical examination Bloodwork Urinalysis Fecal examination Abdominal imaging Radiography Ultrasonography Computed tomography Clinical findings of significant concern Management strategies Fluid therapy Analgesia Active warming Nutritional support Anti-enterotoxemics Intestinal promotility agents Antimicrobials Other medications Surgery Management of specific conditions Intestinal obstruction Liver lobe torsion Appendicitis About the presenter Jo Sheen is an associate veterinarian at Sydney Exotics and Rabbit Vets. Dr. Sheen consults as a primary accession and referral exotic animal medicine veterinarian at Veterinary Specialist & Emergency Centre North Shore in New South Wales, Australia. She graduated from the University of Edinburgh in 2004, and gained her postgraduate qualification in zoological and exotic medicine in 2008. In 2017, she became a Diplomate of the American Board of Veterinary Practitioners in Exotic Companion Mammal Practice. She is only the second Australian veterinarian to achieve these credentials. Webinar recording Post-test Complete the brief quiz. With a passing grade of 80% or higher*, you can download your continuing education (CE) certificate for 1 hour of CE credit in jurisdictions that recognize American Association of Veterinary State Boards (AAVSB) Registry of Approved Continuing Education (RACE) approval. *Since there are only five questions, a passing grade must be 80%. Test your knowledge Expert Q&A Dr. Sheen generously created a pre-recording, so answers to many attendee questions were typed live and are posted below. ENCOMPASSED CONDITIONS What about rabbits who are passing lots of mucous and have a large cecum? This would tend to suggest a cecal dysfunction. If this is an adult rabbit, I would start with looking at husbandry closely. DIAGNOSTICS Is measurement of urine specific gravity (USG) in rabbits useful for assessing renal concentrating ability? Do you recommend urine culture and a urine protein/creatinine (UPC) ratio? USG is invaluable together with other biochemical parameters (blood urea nitrogen, creatinine, K+, phosphorus, etc.) for assessment of renal concentrating ability. Culture and sensitivity and UPC will depend on the case and whether I am concerned about disease(s) associated with the urinary system. Given the huge range of urine specific gravity (USG) in the rabbit at what USG do you consider loss of concentration? Good question! Published ranges are super wide! I would interpret that together with bloodwork and clinical status of animal. For example, if the rabbit is azotemic and showed USG = 1.005, I would probably consider this significant. However, if the rabbit is azotemic and you have diagnosed intestinal obstruction and the rabbit has been receiving intravenous fluids for the past 12 hours, then a USG of 1.010 is likely to be less concerning. When taking a series of x-rays to access the progression of the obstruction how much time should be allowed between each of those? The exact interval will depend on the clinical status of the rabbit. If stable, I usually aim for every 2 hours or so. MANAGEMENT STRATEGIES Is maropitant dosing/administration the same as in dogs or cats? I use the same dose as for dogs/cats: 1 mg/kg SC Ozawa SM, Hawkins MG, Drazenovich TL, Kass PH, Knych HK. Pharmacokinetics of maropitant citrate in New Zealand White rabbits (Oryctolagus cuniculus). Am J Vet Res. 2019 Oct;80(10):963-968. doi: 10.2460/ajvr.80.10.963. PMID: 31556710. Can you share a dose for opioids…? What opioid(s) are you thinking specifically? There are doses published for a number of them (buprenorphine, fentanyl, etc. Visit the Exotic Animal Formulary for specific doses and view the RACE-approved webinar recording Sedation and Pain Management in Exotic Companion Mammals for useful clinical information. Regarding ranitidine discontinuation – we now get cimetidine compounded and use this adjunctively to cisapride. Do you have any thoughts on this? Go right ahead 🙂 Just bear in mind the pro-motility effects of H2 receptor blocks ranitidine > famotidine > cimetidine Does famotidine have pro-kinetic effects, or do you use it as a gut protectant? It is believed to have both. Given the complexity of rabbit GI […]