Case Challenge: A 5-Year-Old Rabbit With Anorexia and Lethargy

  • 5-year old female spayed lop rabbit presents with a history of acute anorexia

    Background

    Chief Complaint:
    First ever episode of decreased appetite and reduced activity for the last 24 hours  |  Failure to produce stools over the last few hours


    Diet:
    Grass hay and a small amount of high-quality, timothy-hay based pellets  |  New bale of hay


    Housing:
    House rabbit | Shares a pen with another lop rabbit who is fine  |  There is also a third rabbit in the same room, also fine  |  No new rabbits  | Although there is an outdoor pen, the rabbit has not yet had access to the yard this year

  • Slide 2 Physical Exam Findings

    Minimum Database

    Hands off:
    Hunched posture, depressed (not moving, not sniffing or lifting head)


    TPR:
    99ºF (37.2ºC)   |   HR: 300 bpm  |  Tachypnea


    Abdominal palpation:
    The stomach is very large and distended with moist ingesta. Some ingesta in the remainder of the GIT but the cecum seems less full than normal  |   Large, distended stomach  |  Findings suggestive of abdominal pain: tensing


    Oral examination
    Tacky mucous membranes

  • Slide 3 venipuncture saphenous

    Minimum Database

    Laboratory results in a 5-year old female spayed lop rabbit.
    Biochemistry panel Complete blood count
    Conventional units SI units*
    ALP 66 U/L (12-96) 66 U/L WBC 8.2 (5.0-12.0)
    ALT 80 U/L (48-70) 80 U/L RBC 6.43 (4.0-7.0)
    AST 221 U/L (33-99) 221 U/L HGB 16.9 (8.8-13.8)
    CK 1971 U/L (140-372) 1971 U/L HCT 55.6 (28.1-42.1)
    GGT 6 U/L (50-140) 6 U/L MCV 66
    T Bili 0 mg/dL 0 µmol/L MCH 22.8
    BUN 46 mg/dL (17-24) 16.4 mmol/L MCHC 34.8
    Cre 1.2 mg/dL (0.8-1.8) 98.4 µmol/L
    Chol 14 mg/dL (24-65) 0.36 mmol/L Hetero 7.05 (3.28-6.22)
    Glu 662 mg/dL (108-160) 36.75 mmol/L Bands 0
    Ca 13.4 mg/dL (8.7-18.4) 3.34 mmol/L Lymph 1.07 (2.42-4.62)
    Phos 5.0 mg/dL (4.0-6.2) 1.61 mmol/L Mono 0
    TCO2 6 mEq/L 6 mmol/L Eos 0
    CL 99 mEq/L (95-115) 99 mmol/L Normal RBC morphology
    K 4.7 mEq/L (3.8-5.5) 4.7 mmol/L Platelets clumped
    Na 133 mEq/L (132-156) 133 mmol/L Sample 1+ hemolyzed
    TP 6.3 g/dL (4.9-7.1) 63 g/L
    ALB 4.5 g/dL (2.7-3.6) 45 g/L
    GLB 1.8 g/dL (2.4-3.3) 18 g/L
    A/G 2.5 (0.7-1.9) 2.5

    *Calculated with the use of:

    GlobalRPH. Conventional units – International units. GlobalRPH Website. Available at http://www.globalrph.com/conv_si.htm. Accessed on July 23, 2015

    Jay Clinical Services. Clinical analyte unit conversion. Jay Clinical Services Web site. Available at http://dwjay.tripod.com/conversion.html. Accessed on July 23, 2015.

  • 4 rad screenshot

    Images provided by Dr. Santiago Díaz. Move forward to see a larger version of each radiograph.

  • rabbit patient lateral Diaz

    Image provided by Dr. Santiago Diaz

  • nml rabbit lateral Diaz

    Image provided by Dr. Santiago Diaz

  • rabbit patient VD Diaz

    Image provided by Dr. Santiago Diaz

  • Slide 8 Normal rabbit VD rad Diaz labeled

    Image provided by Dr. Santiago Diaz

  • Problem List?

  • Problem List

  • DDX slide***Next slide for the answer***

     

  •  

    The best answer is gastrointestinal obstruction. Click here to learn more.

     

    • Dental disease is the most common cause of anorexia in pet rabbits and a normal oral examination in the conscious rabbit cannot completely rule-out dental disease.
    • Ileus is a common clinical problem that can be a primary or secondary disease. Click here for helpful advice on distinguishing non-obstructive gastrointestinal disease from obstructive disease in the rabbit.
    • Mucoid enteropathy is a condition typically seen in juvenile (~14 week old) rabbits fed inadequate dietary fiber and excess concentrate, although disease is occasionally seen in adults. Mucoid enteropathy is characterized by the presence of copious mucus in the colon despite minimal inflammatory changes. The cecum may be impacted. Gastric dilatation occurs in the terminal stages. Rabbits often present with a history of anorexia and depression. Although diarrhea or soft stools can be present early, rabbits often pass thick, gelatinous mucus or mucoid fecal material in the later stages of disease. Evidence of abdominal pain is often also observed. On physical examination the patient is hypothermic, dehydrated, and the cecum palpates firm or solid on abdominal palpation. This condition is progressive and usually fatal. Treatment is the same as for gastrointestinal ileus (Meredith 2008).