See discussions, stats, and author profiles for this publication at: [Link]

net/publication/261179451

Digestive system disease

Chapter · February 2014

DOI: 10.22233/9781910443217.12

CITATIONS READS
10 238

1 author:

Frances Margaret Harcourt-Brown

64 PUBLICATIONS 1,652 CITATIONS

SEE PROFILE

All content following this page was uploaded by Frances Margaret Harcourt-Brown on 23 September 2024.

The user has requested enhancement of the downloaded file.

Digestive
disorders
10
A wide array of digestive disorders affects excreted in hard faecal pellets. Small fibre
rabbits. Diarrhoea, bloat, scours, mucoid particles are sent in a retrograde direction
enteritis, enterotoxaemia, gut stasis, wool- into the caecum where they undergo bacter-
block, trichobezoars, enteritis, gastroen- ial fermentation. Bacterial fermentation
teropathy, mucoid enteropathy are among the within the caecum releases volatile fatty acids
variety of non-specific terms used to describe that are absorbed as an energy source. The
the diseases that affect the gastrointestinal result of bacterial fermentation within the
tract. Many of the digestive disorders that caecum is a fine paste containing amino acids,
afflict pet rabbits are related to diet and only vitamins, enzymes, microorganisms and
a few are caused by enteric pathogens. There volatile fatty acids.
is a complex inter-relationship between the Therefore, the rabbit’s colon has a dual
predisposing factors and causes of digestive function. For most of the day, it mixes and
disease. This inter-relationship is summarized separates ingesta, simultaneously sending
in Figure 10.1. Enteric disease is manifested indigestible particles towards the anus, and
by a disruption in normal faecal production. fermentable particles towards the caecum.
The consistency and frequency of hard Periodically, the motility of the proximal colon
and/or soft faeces are altered. There may or alters completely, and pasty caecal contents
may not be mucus production. The term are directed along the colon to be expelled as
‘diarrhoea’ can be confusing, both to owners soft faecal pellets or caecotrophs. Caecotroph
and vets. A list of differential diagnoses of production follows a diurnal rhythm. Most
‘diarrhoea’ is given in Table 10.1. rabbits produce soft faeces during the morning
and evening approximately 4 h after feeding.
These caecotrophs are re-ingested directly
10.1 Digestive physiology from the anus to be digested in the stomach
and small intestine as an additional source of
A detailed description of the rabbit’s diges- nutrients for the rabbit. The nature of the
tive physiology is given in Section 1.5. Briefly, intestinal contents, muscular activity, transit
the rabbit is a strict herbivore whose digestive time and exchange of water and electrolytes
system is adapted for the ingestion of a alter according to the type of faeces that are
fibrous diet. Digestion in the stomach and passing through the colon. Therefore, diges-
small intestine is similar to monogastric tion and colonic motility can either be in the
animals and food that reaches the hindgut is ‘hard faeces phase’ or the ‘soft faeces phase’
mainly composed of fibre that cannot be (see Figure 1.2). The amount of ingesta and gas
broken down by the digestive enzymes of the in the various sections of the digestive tract
stomach and small intestine. The rabbit has alters according to the phase of excretion. The
the ability to separate large fibre particles size and shape of the caecum also follows a
from small fibre particles in the proximal diurnal rhythm, which is an important consid-
colon. The small particles and the large eration during abdominal palpation or radiog-
undigested particles are simultaneously sent raphy of rabbits.
in opposite directions. Large particles of Separation of ingesta in the proximal colon
undigested fibre pass distally and are is accomplished by a combination of
 PAIN REDUCED APPETITE FOR CAECOTROPHS
Post-operative OBESITY DIET
Low dietary fibre SOFT New foods
Dental PREGNANCY High dietary protein
Visceral LACTATION CAECOTROPHS Individual intolerances
Alterations in odour Insufficient fibre
Musculoskeletal Stress
Perineal ? High carbohydrates
UNEATEN
CAECOTROPHS
INCREASED MOBILIZATION OF
FREE FATTY ACIDS & FATTY RECOVERY INABILITY or
ANOREXIA LIVER with treatment and RELUCTANCE
STRESS dietary modification TO INGEST CAECOTROPHS
Fright Dental disease
Fear Obesity
Pain, RECOVERY DEATH Spondylitis
Poor husbandry GASTRIC IMPACTION with treatment and HEPATIC due to electrolyte Painful perineum
‘TRICHOBEZOAR’ dietary modification LIPIDOSIS imbalances and Large dewlap
DIET dehydration or Neurological problems
Low indigestible enterotoxins Perineal skin folds
A fibre Elizabethan collars
High protein GASTROINTESTINAL HYPOMOTILITY
G High carbohydrate
Change in diet ANTIBIOTICS PROLIFERATION OF INTESTINAL OBSTRUCTION
Clostridia spp. ENTEROTOXAEMIA e.g. pellets of matted hair
E Whole dried pulses
PATHOGENS Impacted caecum
ALTERATIONS IN CAECAL MICROFLORA TOXINS
e.g. plant toxins
STRESS: RECOVERY
Transport, PROLIFERATION OF
Change of environment PATHOGENS ENTERITIS DEATH
Mixing groups
due to electrolyte
REDUCED imbalances and DYSAUTONOMIA
RESISTANCE TO dehydration or
INFECTION PATHOGENS RECOVERY enterotoxins
Coccidia
E. Coli
WEANING POOR HUSBANDRY Salmonella
Gut flora not established Disease buildup Viruses
Exposure to pathogens Tyzzers disease MUCOID DIET
Overcrowding STRESS ENTEROPATHY
Stress Clostridia Low indigestible fibre

Figure 10.1. Inter-relationship of predisposing factors and causes of gastrointestinal disease in rabbits.
 Digestive disorders 251

Table 10.1 Differential diagnosis of ‘diarrhoea’ in rabbits

Syndrome Incidence in Hard faeces Caecotrophs Condition of Causes

pet rabbits rabbit

Uneaten Common Copious Normal Well Obesity

normal quantities of consistency Appetite good Dental disease
caecotrophs hard faecal Spondylosis
(Soft odorous pellets Arthritis
faecal material Perineal dermatitis
that looks like etc.
diarrhoea to
the owner)
Uneaten soft Common Copious Soft, liquid Well Change of diet
caecotrophs quantities of consistency Lack of dietary fibre
hard faecal Succulent foods
pellets Stress
+ same causes as
uneaten normal
caecotrophs
Coccidiosis Rare in adult Diarrhoea can Indistinguishable Depends on Eimeria species
Common in range from from hard faeces severity of
juvenile haemorrhagic condition
liquid faeces to
bulky soft faeces
Mucoid Rare in adult Normal hard Abnormal soft May be eating in Still unclear
enteropathy Associated faeces are caecotrophs may early stages Dysautonomia has
with stress absent be intermittently been found in some
interspersed Bloated cases
Sporadic Mixed or with mucus and appearance
outbreaks interspersed diarrhoea
juveniles mucus and Progresses to
diarrhoea inappetance and
tooth grinding
No faecal output
in later stages
Caecal Sporadic Absence of hard None in later May pick at food Appears to be
impaction incidence faeces stages in early stages associated with pain
or stress
Can produce
mucus which Caecal impaction is
owners mistake also part of mucoid
for diarrhoea enteropathy complex

Can be caused by
ingestion of
materials that are
moved into the
caecum, absorb
water and are not
broken down by
caecal microflora.
Examples include
clay litter,
methylcellulose or
other bulk laxatives
Enteritis Rare in Normal hard Not seen Unwell Bacterial or viral
adults faeces are Anorexic pathogens such as
absent May crave fibre E. coli, clostridia,
Enteritis rotaviruses etc.
caused by Liquid diarrhoea Can be induced by
bacterial antibiotics
overgrowth/ Plant toxins
imbalances
are more

continued
252 Textbook of Rabbit Medicine

Table 10.1 continued

Syndrome Incidence in Hard faeces Caecotrophs Condition of Causes

pet rabbits rabbit

common in
the suckling
or growing
rabbit
Enterotoxaemia Sporadic Liquid faeces Not seen Unwell Clostridial species
cases in that may be Rapidly Can be induced by
adult rabbits tarry progressive antibiotics
Maybe collapsed
More Rabbit may die
common in before diarrhoea
juveniles develops
Chronic Rare Large amounts Indistinguishable Thin, bloated Not known
inflammatory Only adults of bulky soft from hard faeces Periods of ? immune mediated
disease faeces ravenous appetite Sometimes
interspersed with associated with
periods of adhesions ? post
anorexia spay

In other species, diarrhoea is manifested by the frequent evacuation of watery droppings (Blood and Studdert, 1999).
Rabbits produce two types of droppings, i.e. hard faeces and caecotrophs. Normal caecotrophs are soft in consistency and
are often mistaken for diarrhoea. The nature and frequency of both types of faeces are an important consideration. In some
conditions, there is also excessive mucus production that can be mistaken for diarrhoea.

functional anatomy and colonic motility. and separating and is sent into the caecum
Sacculations in the wall of the proximal colon with the small particles. Water is absorbed
(haustra) retain small particles while the larger from the caecum across the caecal wall into the
particles accumulate in the lumen. Haustral circulation. The retention time of digesta
activity directs small particles towards the within the caecum is affected by both caeco-
caecum, while segmental activity directs large colonic motility and the nature of ingesta that
particles towards the anus. Lagomorphs have reaches it. Conditions within the caecum are
a specially adapted muscular segment of the affected by the type and amount of nutrients
colon known as the fusus coli that contains a that supply the microflora and the products of
large number of mucus glands (see Plate 22). bacterial fermentation. The balance of microor-
The fusus coli acts as pacemaker for colonic ganisms in the caecum is of paramount impor-
motility. It is highly innervated and vascular tance to the health of the animal. A healthy
and is not only controlled by the autonomic microflora digests food efficiently. Any factor
nervous system but is also subject to the that upsets the balance of caecal microflora has
effects of metabolites and hormones such as the potential to result in the proliferation of
aldosterone and prostaglandins. During the pathogenic bacteria and cause disease.
excretion of caecotrophs, haustral activity
ceases and caecal material is moved swiftly
along the large colon. In the fusus coli, the 10.2 Inter-relating factors in
material is formed into pellets that become digestive disease
encapsulated in mucus (see Plate 22). The
transit time for soft faeces through the colon 10.2.1 Intestinal microflora
is 1.5–2.5 timeS faster than for hard faeces
(Fioramonti and Ruckesbusch, 1976). The caecum is a finely balanced ecosystem
Within the caecum lies a complex ecosystem composed of a variety of microorganisms
of microflora nourished by water and digesta nourished by a constant supply of water and
that arrive from the small intestine via the nutrients from the small intestine. Changes in
proximal colon. Water is secreted into the the amount and content of the ingesta that
proximal colon during the process of mixing reaches the caecum have an effect on the
 Stomach
Xiphisternum (reflected)
Pancreas
Liver Liver (left lobe)
Duodenum Stomach
Pancreas (right lobe) in omentum
(descending part) Duodenojejunal Spleen
E Duodenum
D flexure (descending part) E D Distal colon
Duodenum
(ascending part) Distal colon D (transverse
D (ascending colon colon)
Pancreas C
Jejunum C Duodenojejunal
(right lobe) in Ileum
Fusus coli flexure
mesoduodenum Lower proximal
(ascending colon) Distal colon
colon (ascending
A Upper proximal colon A (descending
colon)
B (ascending colon) colon)
B
Lower proximal Sacculus rotundus
colon (ascending Sacculus rotundus
colon) Ampulla coli
Caecum

(a) (b) (c)

Figure 10.2. Three-dimensional topographical anatomy of the abdominal contents of the rabbit with the caecum
removed. Figure 10.2 illustrates the topographical relationship of the liver, spleen, pancreas, small intestine and colon at three
levels from superficial (ventral) to deep (dorsal). The diagrams were drawn from fresh dissections after removal of the caecum. Each
of the three drawings shows the small intestine in green and the large intestine in black. Dotted lines show structures that are
deeper (more dorsal) than the illustrated layer. The progression through the bowel from stomach to anus is shown by arrows. The
intestines are held firmly in place by their mesenteric attachments.
Digestive disorders 253
254 Textbook of Rabbit Medicine

balance of microorganisms, which are there- that rabbits would not normally eat, alter-
fore dependent on diet and intestinal motility. ations in the intestinal microflora can rapidly
Bacteroides spp. predominate in a microflora result in the proliferation of pathogens and
composed of aerobic and anaerobic gram- the development of enteritis. Large numbers
positive and gram-negative rods, cocci, of pathogenic bacteria are most likely to be
filaments, coccobacilli and spirochaetes. In present in intensive situations. Commercial
addition to the aerobic flora, over 74 strains of rabbits are young, growing animals, in which
anaerobic bacteria have been isolated from the a healthy caecal microflora has not become
caecal mucosa and many of these species have established. Because of the financial impor-
not been cultivated (Straw, 1988). The micro- tance of losses due to enteric disease in
bial flora can contain small numbers of poten- commercial units, extensive research has been
tial pathogens such as Clostridium spp. Stress carried out into the effects of varying dietary
has an effect on caecal microflora. Increased protein, carbohydrate and fibre levels on
glucocorticoid levels increase coliform counts caecal microflora and volatile fatty acid
and narrow the aerobic to anaerobic bacteria production. These considerations are beyond
ratio in the gut (Straw, 1988). Changes in the the remit of this book, which is mainly
caecal microflora can be seen in gram-stained concerned with the individual pet rabbit and
smears of caecal contents. In the healthy not commercial rabbit production. The nutri-
rabbits, high numbers of large anaerobic tion of the commercial rabbit is described in
metachromatic bacteria (LAMB) and protozoa detail by P.R. Cheeke (Rabbit Feeding and
are present. In rabbits suffering from mucoid Nutrition, 1987, Academic Press, Orlando)
enteropathy, a drop in the number of LAMB and reviewed in The Nutrition of the Rabbit
and protozoa and an increase in coliforms are (eds C. De Blas and J. Wiseman, 1998, CAB
found (Lelkes and Chang, 1987). Publishing, Wallingford, Oxford).
The caecal microflora synthesize volatile
fatty acids that are absorbed across the caecal
wall into the circulation. Anaerobic Bacteroides 10.2.2 Diet
are the principal source of butyrate that is
used as an energy source for the caecal It is not possible to consider any digestive
epithelium. The caecal epithelium is adapted problem in rabbits without examining the diet.
for the efficient absorption of water and The role of fibre and its ‘digestibility’ or
electrolytes. Butyrate is also important in the ‘indigestibility’ is an important concept in the
regulation of caecal pH, which has an understanding of digestive disease in rabbits.
optimim of 5.7–6.1. Changes in caecal pH Fibre digestion depends upon the presence of
alter the caecal microflora and can result in cellulolytic bacteria within the digestive tract.
the proliferation of pathogens. The propor- In rabbits the term ‘digestibility’ includes bacte-
tions of volatile fatty acids in the caecum rial degradation or fermentation within the
influences appetite and gut motility. In caecum, and not just digestion in the stomach
healthy rabbits, acetates predominate, and small intestine. For this reason, the term
followed by butyrates and proprionates. Low ‘fermentable fibre’ may be less confusing than
fibre diets result in decreased acetates and ‘digestible fibre’. Bacterial fermentation of fibre
increased proprionates and butyrates. An within the caecum varies according to the
increase in caecal butyrate inhibits normal chemical structure and particle size (see Figure
peristalsis of the gut (Lang, 1981). 2.2). For example, hemicellulose is more
The microflora of the rabbit’s digestive tract digestible than lignin. Small particles enter the
changes according to the age and diet of the caecum where their digestibility is affected by
animal. In wild rabbits and those pet rabbits their size. Smaller particles of fermentable fibre
that eat a natural diet of grass and hay, a have a relatively greater surface area for bacte-
healthy gut flora becomes established that is ria to adhere to and are digested more quickly
resilient to any minor dietary changes that than the larger particles. Very large particles
occur as the result of eating novel foods. In (> 0.5 mm) do not enter the caecum and are
contrast, in intensive situations where large expelled, undigested, in the hard faeces.
numbers of rabbits are kept in a small space Although it has no nutritive value, indigestable
and fed on artificial diets containing products fibre is an essential part of the diet because it
 Digestive disorders 255

Figure 10.3. Radiographic anatomy of lateral view of normal abdomen. Interpretation

of abdominal radiographs is summarized in Box 10.1. Figure shows a lateral radiograph of a
healthy 2-year-old neutered male rabbit (no nipples are evident). The radiograph was taken
during mid-morning and the colon is in the soft faeces phase. Hard faecal pellets are not
evident in the rectum. The ileocaecocolic complex that occupies the caudoventral abdomen is
relatively small and the contents amorphous. Gas shadows can be seen in the distal colon.
Both kidneys, the stomach, liver and bladder can be seen.

stimulates gut motility, which sends nutrients needed to cause pathological disease in
and fluids into the caecum for bacterial fermen- commercial rabbits fed on a low fibre diet
tation. Insufficient indigestible fibre results in (Licois and Mongin, 1980). The caecal appendix
slow gut motility and retention of hair and is larger in rabbits on a low fibre diet suggest-
ingesta in the stomach. Reduced motility in the ing either an increased demand for the buffer-
proximal colon affects the separation of intesti- ing effects of bicarbonate or an increase in
nal contents and reduces the supply of digesta lymphoid activity in response to greater
and fluid to the caecum. Lack of both production of bacterial toxins (Cheeke et al.,
fermentable and indigestible fibre results in 1986).
changes in caecal pH, volatile fatty acid distri- The amount of indigestible (non-
bution and the balance of microbial flora. Alter- fermentable) fibre in the diet has an effect on
ations in the populations of microorganisms appetite, both for food and for caecotrophs.
can allow enteric pathogens to proliferate. High levels of indigestible fibre promote
Therefore, although a low level of dietary fibre caecotroph ingestion whereas high protein
may not actually cause disease, it is a major levels reduce it. More food is consumed by
predisposing factor. Additional factors such as rabbits on a diet high in indigestible fibre, i.e.
coccidiosis or treatment with ampicillin are large particles of lignified plant material.
256 Textbook of Rabbit Medicine

However, processing the food to reduce the often stressed by change of housing and diet,
indigestible fibre down to particles small transport and mixing with different individu-
enough to enter the caecum will suppress als. Intercurrent disease such as pasteurellosis
appetite. Lignin is not digested by the caecal can be present. Minimizing stress and a diet
bacteria whereas cellulose, hemicellulose and containing sufficient indigestable fibre is
pectin are. Excessive amounts of ground ligni- especially important at this age to prevent
fied material in the caecum increases retention enteric disease.
time and decreases digestibility (Chiou et al., In the adult pet rabbit, infectious causes of
1998). Caecal impaction can be the result. enteritis are rare in comparison with the
young commercial rabbit. Instead, it is far
more common to see diet-related problems.
10.2.3 Age and husbandry Dietary changes can result in the production
considerations of soft caecotrophs that are left uneaten.
Instead, the caecotrophs are deposited in the
The digestive disorders of the young rabbit, bedding or are found stuck to the fur under
especially around the time of weaning, are the tail. The smelly faecal mass is often
very different from the adult pet. The mistaken for ‘diarrhoea’ by the owner,
stomach pH of suckling rabbits is approxi- although it is not caused by infection (see
mately 5–6.5. Adult rabbits have a stomach Section 10.6).
pH of 1–2, except during digestion of
caecotrophs when the pH rises. The high pH
of suckling rabbits not only permits healthy 10.2.4 Effect of digestive disease
bacteria to pass through the digestive tract on water and electrolyte exchange
and colonize the hindgut, but also permits the
passage of pathogens, such as pathogenic The effects of gastrointestinal disease on the
strains of E. coli. Susceptibility to pathogenic water, electrolyte and acid–base balance of
strains of E. coli varies with age; rabbits of 3 rabbits are complex. Disturbances in water,
weeks are more susceptible than rabbits of 6 electrolyte and acid–base balance have a
weeks of age (Licois et al., 1992). Weaning is rapid and profound effect on health. Water
a stressful period for rabbits when healthy and electrolytes are continually exchanged
caecal microflora is not yet established and along the digestive tract and, in rabbits, any
juvenile rabbits are susceptible to disease. condition that affects this cycle of secretion
Ingestion of maternal caecotrophs aids the and absorption also affects fluid and
population of the caecum with a healthy gut electrolyte balance (see Figure 1.2). Saliva is
flora and early weaning and separation from constantly produced by rabbits and, during
the dam increase susceptibility to bacterial the hard faeces phase, water is secreted into
enteritis. the stomach and proximal colon. It is then
After weaning, ammonia levels in the reabsorbed from the caecum and distal colon.
caecum decrease as the diet changes. Caecal Dehydration develops rapidly during intesti-
pH becomes more acidic as volatile fatty acid nal disease, despite no obvious fluid loss in
concentrations increase. The proportions of vomit or diarrhoea. Conditions that cause
individual volatile fatty acids alter with the intestinal obstruction result in the accumula-
change of diet from milk to solids. Proprion- tion of large amounts of fluid proximal to the
ate, valerate and branched chain fatty acids site of obstruction. Conversely, gastrointesti-
predominate until the rabbit starts to eat solid nal hypomotility reduces the secretion of
food. The microbial flora changes in associa- water into the stomach and results in
tion with alterations in volatile acid produc- impaction of the contents. Dehydration is
tion (Padilha et al., 1995). Pathogenic strains associated with gastrointestinal hypomotility,
of E. coli, Clostridia spp., coccidiosis or presumably due to decreased absorption of
rotaviruses are likely to be present in the water from the stomach, caecum and distal
environment of newly weaned rabbits. colon.
Several animals sharing a small space Mucus is rich in potassium (Riley and
increase faecal contamination and the risk of Cornelius, 1989) and a feature of enteropathy
cross-infection. After weaning, rabbits are in rabbits is the production of large amounts
 Digestive disorders 257

Key points 10.1

of mucus. Diarrhoea can result in
• There is a complex inter-relationship hypokalaemia (Licois et al., 1978).
between stress, diet, gut motility and The absorption and secretion of electrolytes
infectious agents in the aetiopathogen- along the digestive tract is also affected by
esis of digestive disorders in rabbits changes in acid–base status. In a study by
• Enteritis is more commonly encoun- Charney et al. (1983), alkalosis in rabbits
tered in the young, commercial rabbit decreased the absorption of water, sodium
kept in intensive conditions than in the and chloride whereas acidosis had the
adult, individual pet with an established opposite effect and reduced bicarbonate
gut flora secretion. Anorexia in rabbits can quickly
• A variety of non-specific terms are used
to describe the array of digestive
lead to metabolic acidosis (see Section 10.3.2)
diseases that afflict rabbits. Examples and the limited ability of the rabbit kidney to
include: bloat, mucoid enteritis, gut correct acid–base disorders makes the species
stasis, wool-block and gastroenteropathy vulnerable to the effects of acidosis or alkalo-
• Water and electrolytes are continually sis (see Section 1.6.5). Changes in acid–base
absorbed and secreted along the diges- status can affect the contractility of the proxi-
tive tract. Dehydration and electrolyte mal colon (Lofqvist and Nilsson, 1981) which,
imbalances occur readily as a result of in turn, will affect the secretion of water and
intestinal disease its absorption from the caecum.
• The role of digestible (fermentable) and Therefore, effective fluid therapy is a vital
indigestible (non-fermentable) fibre in the
digestive physiology is an important
part of the treatment of many gastrointestinal
concept in the understanding of digestive diseases in rabbits (see Section 4.11). Intra-
disease. Fibre is composed of constituents venous or intraosseous fluid therapy is neces-
of plant cell walls and includes cellulose, sary for most cases. Although subcutaneous
hemicellulose and lignin fluids can be used, they are not suitable for
• Indigestible fibre consists of large parti- ill, dehydrated or hypotensive patients as
cles of lignified material that are absorption of fluids from under the skin is
directed into the colon and do not enter poor when peripheral tissue perfusion is
the caecum. It has no nutritive value but reduced by shock or hypovolaemia.
stimulates gut motility
• Fermentable fibre is composed of small
particles that are directed into the
caecum to act as a substrate for the 10.3 Gastrointestinal
caecal microflora. It is mainly hypomotility
composed of hemicellulose and cellu-
lose. Fermentable fibre has no direct
effect on gut motility
• The rabbit’s caecum is an ecosystem
10.3.1 Gastrointestinal
containing a microflora that is essential hypomotility and formation of
to the health of the rabbit. A healthy trichobezoars (hairballs)
caecal microflora requires a constant
supply of nutrients and fluid. Alter-
ations in the balance of microorganisms
Optimum gastrointestinal motility is impor-
within the caecum can result in prolif- tant for digestion of food, absorption of water
eration of pathogenic bacteria and electrolytes and maintenance of a healthy
• Optimal gut motility is important to gut flora. Many factors influence gastroin-
maintain absorption and secretion of testinal motility in rabbits (see Box 10.1).
water and electrolytes along the diges- Reduced gastrointestinal motility leads to
tive tract and to transport nutrients and impacted food in the stomach or caecum,
fluid to the caecum impaired glucose absorption and a reduction
• The limited ability of the rabbit kidney in the supply of nutrients and fluids to the
to regulate acid–base disturbances caecal microflora.
makes this species vulnerable to acido-
sis and electrolyte imbalances. Fluid
For many years, the presence of impacted
therapy is an essential part of treatment hair and food material in the stomach
of many digestive disorders. (‘trichobezoars’ or ‘hairballs’) was believed to
be the cause of disease in rabbits. It was
258 Textbook of Rabbit Medicine

Box 10.1 Interpretation of abdominal radiographs

The rabbit’s digestive processes follow a bowel can be identified by their anatomi-
natural circadian rhythm that affects the cal position (see Figure 10.2)
appearance of abdominal radiographs. It is • The ileocaecocolic segment occupies most
important to consider the time of day that an of the ventral abdomen. The appearance
X-ray was taken, and whether the rabbit had of the ileocaecocolic segment varies with
recently ingested food. the phase of digestion
• Extraneous radiopaque material is
Hard faeces phase sometimes seen in the digestive tract of
During the phase of hard faeces formation and rabbits that eat food that contains particles
excretion, the stomach can contain large of soil or grit. Small particles are moved in
quantities of fibrous food. The caecum a retrograde fashion into the caecum.
becomes progressively distended as ingested Accumulations of sand or grit in the
food passes down the small intestine and caecum should be differentiated from
through the ileocolic junction. A full caecum calcification in abscesses in organs such
and proximal colon gives the ventral abdomen as the ovaries
a general mottled appearance. The outline of • Radiopaque deposits in the bladders are
the caecum is sometimes visible. Hard faecal due to the presence of calcium carbonate
pellets are often seen in the distal colon. Small in the urine. This is a normal finding. A
amounts of intestinal gas may be seen. solid radiopaque bladder suggests the
Soft faeces phase presence of ‘sludgy urine’ (see Figure 14.1)
The soft faeces phase is much shorter than • The left kidney is usually clearly visible in
the hard faeces phase and usually occurs the dorsal abdomen in the region of L3–L5.
during the morning. A small amount of food The right kidney may be less obvious and
may be seen in the stomach. The caecal is situated cranially in the region of T13–L1.
contents are expelled into the proximal Renal length is approximately 1.25–1.75
colon so the caecum is reduced in size. The times the length of the second lumbar
caecum may contain small quantities of gas. vertebra (Hinton and Gibbs, 1982)
Hard faecal pellets are absent from the distal • The presence of intra-abdominal fat
colon and rectum. enhances the radiographic image of
abdominal organs. The area cranial to the
Radiographic findings bladder is filled with fat deposited in the
• The stomach is situated within the costal broad ligament in female rabbits and may
arch and normally contains some food, be seen as a homogeneous grey area,
which gives the organ a mottled appear- especially in obese individuals
ance • The uterus is not normally visible in the
• The main body of the stomach lies on the non-pregnant doe but may be seen if it is
left on the ventrodorsal view enlarged by pregnancy or disease
• The liver can be seen in the anterior • Nipples can be seen superimposed on the
abdomen although the ventral border is abdominal contents of some female
not always clearly demarcated on the rabbits. Nipples are rudimentary in males
lateral view • Sometimes mineralization of ovaries,
• The spleen cannot be seen radiographically uterine tumours or intra-abdominal
• The small intestine cannot be distin- abscesses may be seen
guished from the long distal colon in the • Areas of calcification may be seen in
normal rabbit. Small pockets of gas may association with soft tissue mineralization
be seen in the intestines of normal rabbits chronic abscesses or in areas of fat necro-
• Obstruction or slowing of gut motility sis. Hard areas of necrotic fat in the
results in the accumulation of gas in parts mesometrium can be a sequel to ovaro-
of the digestive tract. Distended loops of hysterectomy.

thought that the trichobezoar caused a pyloric a trichobezoar. Many theories were put
obstruction. Anorexia, weight loss, reduced forward about the cause of trichobezoar
faecal output, depression and death due to formation. Handbooks and leaflets on rabbit
starvation were attributed to the presence of care suggest that regular grooming is
 Digestive disorders 259

Box 10.2 Factors that affect gut motility

• Phase of faecal excretion: the nature • Motilin: this is a polypeptide hormone
and direction of the peristaltic waves alters secreted by enterochromaffin cells of the
with the excretion of hard or soft faeces. duodenum and jejunum. Motilin stimu-
The fusus coli is a specially adapted area lates gastrointestinal smooth muscle. Fat
of the colon that acts as a differential stimulates and carbohydrate inhibits its
pacemaker for the initiation of peristaltic release. In the small intestine, motilin
waves in the proximal and distal colon. activity is decreased aborally. It disappears
The fusus coli is under autonomic control. in the caecum and reappears in the colon
It is highly innervated and is influenced by and rectum
hormones such as aldosterone and • Pain and stress: cause adrenergic stimu-
prostaglandins. Prostaglandin stimulates lation and inhibit gut motility
the excretion of soft faeces • Disease: e.g. dysautonomia, coccidiosis,
• Indigestible fibre: the passage of large E. coli, rotavirus, enterotoxins, plant toxins
particles of indigestible fibre through the can affect gut motility in different ways.
colon stimulates intestinal motility as a For example, in rabbits with diarrhoea
result of intestinal distension experimentally induced by coccidiosis, the
• Volatile fatty acids in the caecum: an motility of the caecum is increased and the
increase in caecal butyrate inhibits normal motility of the ileum and jejunum is
peristalsis of the gut. Low fibre diets result reduced (Fiaramonti et al., 1981)
in decreased acetates and increased • Pharmacological agents: e.g prokinet-
proprionates and butyrates ics, opioids, NSAIDS.

required to prevent excessive amounts of hair gled in the food is also a normal finding
being swallowed and becoming impacted in because rabbits are continually grooming and
the stomach. Some breeders still recommend ingesting large amounts of hair.
one day a week without food for rabbits in In 1984, Leary et al. attempted to induce the
order to ‘clear the system’ of ingested hair. clinical syndrome associated with the
Boredom, magnesium or copper deficiency, presence of trichobezoars by the orogastric
inadequate protein, individual caging and the infusion of latex to reproduce a gastric
presence of air filtration barriers have all been foreign body. Monthly radiographs were
put forward as potential causes of trichobe- taken and the rabbits monitored closely for
zoar formation (Ojerio and Ladiges, 1981). food intake and faecal output for 24 weeks
The rabbit’s inability to vomit has also been after infusion. Gastrotomies were then
cited as a contributory factor (Gillett et al., performed to remove the foreign material and
1983). Treatment was usually unsuccessful. the rabbits monitored closely for a further 4
The administration of liquid paraffin to lubri- weeks prior to euthanasia and post-mortem
cate the gastric contents or pineapple juice to examination. The presence of a latex bezoar
dissolve the hair enzymatically with brome- did not have any adverse effect on appetite
lain were suggested as therapies. Surgical and weight gain of any of the 12 rabbits that
removal of the trichobezoar was a last resort were infused. In the same study, the stomach
and carried a poor prognosis. The association contents of 208 clinically healthy commercial
between trichobezoars and fatty liver was rabbits were examined after slaughter and
noted by many authors (Ojerio and Ladiges, well-defined trichobezoars were found in
1981; Gillett et al., 1983). An association with 23% of them. This study cast doubt on the
pregnancy toxaemia was made by Patton et al. concept that trichobezoars cause anorexia. In
(1983). It is only in recent years that trichobe- 1986, Fekete and Bokori found elevated corti-
zoars have been recognized as the result of sol levels in rabbits with trichobezoars,
anorexia rather than the cause. On post- although they concluded that the elevation
mortem examination, the rabbit’s stomach is was associated with the stress of having a
never found to be empty (Okerman, 1988) trichobezoar rather than the trichobezoar
and the presence of a small amount of fibrous being the result of stress. In 1987, Buckwell
food is normal. The presence of hair entan- described the successful medical treatment of
260 Textbook of Rabbit Medicine

Figure 10.4. Lateral view of a rabbit with gastrointestinal hypomotility showing

presence of a trichobezoar (hairball). Figure is an oblique view of a 3-year-old, obese
female rabbit with gastrointestinal hypomotility. Gas shadows are evident in the stagnant
caecum and stomach. The stomach contains a mass of impacted food and hair that has
resulted from a decrease in gastrointestinal motility (see Section 10.3.1). The initiating cause
was unknown, the rabbit was presented in a moribund state and subsequently died. Post-
mortem examination confirmed the presence of hepatic lipidosis. There was also fatty
degeneration of the kidneys.

‘gut stasis’ in rabbits exhibiting anorexia, frequently in a group of laboratory rabbits

reduced water intake, depression, weight loss that were restrained without the use of a
and absence of faecal pellets. He described towel. Once towel wrapping was introduced
the presence of a palpable impacted mass in for the restraint of all rabbits, the incidence of
the region of the stomach. Treatment the trichobezoars fell dramatically and the
consisted of the administration of a motility author concluded that stress played a signifi-
stimulant, corticosteroid, oral fluid and the cant role in the cause of the disease. Stimula-
provision of hay. Since that time, trichobe- tion of the sympathetic nervous system
zoars have increasingly become recognized as causes adrenal hormones to be released into
the result, rather than the cause, of reduced the circulation. One of the effects of adrena-
gastrointestinal motility and are secondary to line and noradrenaline is the inhibition of
many other conditions. gastrointestinal motility. If gastrointestinal
Pain, stress and fright can all reduce motility is reduced, water secretion into the
gastrointestinal motility and lead to the stomach is also reduced and hair and ingesta
accumulation of hair in the stomach and the accumulate and become impacted. The rabbit
formation of trichobezoars. In one study by appears to be particularly susceptible to the
Jackson (1991), intestinal stasis occurred more effects of catecholamines on gut motility. In
 Digestive disorders 261

healthy rabbits with an uninterrupted daily 10.3.2 Anorexia and development

routine, the passage of soft and hard faeces of hepatic lipidosis
follows a circadian rhythm with an average
day-to-day variation of approximately 30 Anorexia, whatever the cause, can trigger a
minutes. Stress or even alterations in routine chain of events that can result in death of a
can have a significant effect on the rabbit from hepatic lipidosis and liver failure.
caecotrophic rhythm. Simply switching a Rabbits are obligate herbivores and their
light on during the normal period of darkness carbohydrate metabolism differs from carniv-
caused one rabbit to stop producing faeces for orous species such as the dog or cat. The
10 days in a study of caecotrophic rhythm by endocrine control of the storage and
Jilge (1980). Thunderstorms, bonfire night, mobilization of food are not as important in
predator attacks, pain and surgery can all herbivorous species as in carnivores that eat
slow gut motility and, if left untreated, result periodically and need to regulate a fluctuat-
in impacted stomach contents and trichobe- ing supply of nutrients from the digestive
zoar formation. tract. Herbivorous animals withstand the
Gut motility is affected by the indigestible absence of insulin far more readily than
fibre component of the diet. The provision of a carnivorous ones (Bentley, 1998).
high fibre diet has long been recognized as a In rabbits, glucose and lactates are
preventative measure for the formation of produced in the caecotrophs during the
hairballs (Sandford, 1996). Rabbits fed on a low period of fermentation in the stomach and are
fibre diet are at greater risk of developing absorbed during digestion of caecotrophs in
gastric stasis and trichobezoar formation. the small intestine. Amylase is synthesized by
Rabbits with slow gut motility crave fibre and the caecal flora and is present in caecotrophs
will often eat hay or grass in preference to other to act on the carbohydrates that are present.
foods. The provision of palatable indigestible Volatile fatty acids are a major energy source
fibre for rabbits that are at risk of gut stasis, e.g. and represent about 40% of the maintenance
postoperatively, is important. Fresh grass is the energy requirement of rabbits (Marty and
most acceptable form of fibre for rabbits, Vernay, 1984). They are absorbed from the
although good quality hay is acceptable. digestive tract during digestion of
Slow gut motility not only results in the caecotrophs and from the caecum where
development of trichobezoars. Gas accumu- volatile fatty acids are produced by bacterial
lates in the stagnant stomach and caecum. fermentation. Concentrations of volatile fatty
Visceral distension causes pain that stimu- acids in arterial blood are kept constant by
lates catecholamine release and exacerbates the liver, despite fluctuations in absorption
inhibition of gut motility. Gastric ulceration from the digestive tract. Volatile fatty acid
can occur. Alterations in the secretion and absorption from the gut varies with the hard
absorption of water and electrolytes cause or soft phase of faecal excretion (Vernay,
dehydration and electrolyte imbalances. 1987) and is affected by gut motility. Lipids
Reduced food intake leads to an energy are absorbed from the diet or are derived
deficit that stimulates mobilization of free from endogenous synthesis of free fatty acids
fatty acids from adipose tissue and fatty infil- in the liver (Madry et al., 1976).
tration of the liver. Ketoacidosis and hepatic During periods of anorexia, glucose
lipidosis are the result. Liver failure from absorption from the gut falls and there is a
hepatic lipidosis is the usual end-point of reduction in volatile fatty acid production by
untreated gastrointestinal stasis. the caecal microflora. The resultant drop in
Reduced food intake and hypomotility of glucose and glucogenic volatile fatty acid
the proximal colon also reduce the amount of absorption results in hypoglycaemia that
ingesta that is available as substrate for caecal stimulates lipolysis and the mobilization of
microflora. Alterations in the caecal fermen- free fatty acids from adipose tissue. The free
tation patterns can lead to changes in caecal fatty acids are transported to the liver to be
pH and volatile fatty acid production. The metabolized as an energy source. The major
balance of caecal microflora changes with the pathway for their degradation is that of ␤-
possibility of the proliferation of pathogenic oxidation and ketone body production.
bacteria such as Clostridia spp. Ketoacidosis occurs when ketone body
262 Textbook of Rabbit Medicine

production exceeds tissue metabolism. show a period of insulin resistance between

Rabbits do not have effective metabolic days 24 and 30 of gestation during which
pathways for correcting acidosis (see Section high levels of insulin do not stimulate muscle
1.6.5) and are particularly susceptible to the glucose uptake (McLaughlin and Fish, 1994).
effects of ketoacidosis. Also, during periods Hepatic uptake of glucose and free fatty acids
of increased mobilization of free fatty acids, a is also reduced in pregnant rabbits and brings
‘bottleneck’ develops in the liver, which about an arterial hyperglycaemia so more
impairs the metabolic pathways that result in glucose is available to the uterus (Pere et al.,
lipid transport to other tissues. Fat accumu- 1992). Insulin resistance results in increased
lates in the hepatocytes causing cholestasis hormone sensitive lipase (HSL) activity with
and eventual liver failure and death. Hepatic increased amounts of triglyceride being
lipidosis occurs most readily in obese rabbits hydrolysed from adipose tissue and trans-
because they have already accumulated ported to the liver.
triglycerides in the hepatocytes. Pregnant does are susceptible to the effects
of anorexia and a drop in blood glucose
rapidly stimulates fatty acid mobilization
10.3.3 Obesity, pregnancy from adipose tissue to a liver that is already
toxaemia and hepatic lipidosis being compromised by fatty infiltration. An
association between hairballs and pregnancy
Any condition that causes prolonged toxaemia was made by Patton et al. in 1983
anorexia in rabbits can result in fatty infiltra- illustrating the complex inter-relationship
tion of the liver. Stress alone alters the fat between anorexia, fibre, gastrointestinal
metabolism of rabbits, especially in those that motility, energy demand and fatty infiltration
are already overweight. In a study by of the liver. Treatment of pregnancy toxaemia
Lafontan and Agid (1979), minor stressful is unlikely to be successful, but follows the
stimuli such as saline injections or venepunc- same principles as the treatment of hepatic
ture induced a prompt increase in plasma free lipidosis, apart from the complication of the
fatty acid and glycerol concentrations in fetuses. Pregnancy toxaemia can be prevented
naturally obese rabbits. This increase did not keeping breeding does slim and feeding them
occur in younger, lighter rabbits. Alpha- a high fibre diet.
adrenergic responsiveness is increased in the
large fat cells of obese rabbits in comparison
with the small fat cells of underfed rabbits
(Lafontan, 1981). High fat diets greatly 10.3.4 Diagnosis and treatment of
increase the risk of hepatic lipidosis. In a gastrointestinal hypomotility and
study by Jean-Blain and Durix (1985), rabbits prevention of hepatic lipidosis
that were fed on a high fat diet showed a two-
fold increase in ketonaemia during a period Hepatic lipidosis can be prevented in
of fasting and were more hypoglycaemic than anorexic rabbits by maintaining a positive
rabbits that were fed on a low fat diet. energy balance with nutritional support and
Obesity is a major problem in pet rabbits and prompt treatment. It is important that rabbit
animals that already have fatty livers can owners are made aware that anorexia, in
rapidly develop hepatic lipidosis if they conjunction with lack of faecal output, is a
become anorexic. Any surgical procedure in potentially fatal condition and that rabbits
an obese rabbit carries a risk of hepatic lipido- that are not eating must be treated promptly.
sis associated with pain, stress and withhold- Hospitalization and intensive nursing are
ing food. often required.
It is well known among the rabbit breeders There are many differential diagnoses for
that female rabbits should not be too fat if the underlying causes of anorexia and
they are to breed successfully. Rabbits with gastrointestinal hypomotility, including
fatty livers readily develop ketosis dental disease and recent surgery (see Table
(pregnancy toxaemia) in late pregnancy or 3.2). Recognition and treatment of the under-
during early lactation when glucose require- lying cause is an essential part of treatment.
ments are high. Healthy pregnant rabbits The onset of gastrointestinal hypomotility can
Table 10.2 Therapeutic agents used in the treatment of enteric disorders

Enteric disorder Prokinetics Narcotic NSAIDs Anti-ulcer Anti- Choles- Liquid Probiotics Fluid therapy Nutritional support
analgesics drugs biotics tyramine paraffin

Gastrointestinal    In long- X X In Maybe Oral fluids to Provide indigestible

hypomotility Essential Except in standing advanced useful soften stomach fibre
‘hairballs’ mild cases cases cases to adjunct to contents and to Provide tempting foods
lubricate treatment provide water Syringe feed if
impacted and electrolytes necessary:
stomach Intravenous carbohydrate to supply
contents fluids in later energy and prevent
stages hepatic lipidosis
Nasogastric tube as a
last resort
Uneaten X May need If perineal X If X X Maybe X Increase indigestible
caecotrophs sedation skin is perineal useful fibre i.e lots hay/grass
to clean inflamed skin is adjunct to
perineum inflamed treatment
Intestinal X      X Maybe 
obstruction/ Contra- Essential Postop Postop Postop useful Intravenous (or Tempting foods
gastric indicated adjunct to intraosseous) required post-
dilatation treatment fluids are operatively
essential
Caecal   Use  X X  Maybe  Tempting foods
impaction Bupre- carprofen if useful Easily digested foods
norphine NSAID is adjunct to e.g baby foods.
required. treatment No small fibre particles
Less likely that cannot easily be
to interfere digested by caecal
with bacterai.
caecotroph
production
Enteritis X  ? ?   X Maybe Essential. Hay/grass
useful Oral or subcut. Excel
adjunct to in early stages
treatment Intravenous in
later stages
Enterotoxaemia X   X Metro-  X Maybe Essential Hay/grass
nidazole useful Intravenous or Excel
adjunct to intraosseous
treatment
Mucoid        Maybe  Hay/grass
enteropathy useful Tempting foods
adjunct to
treatment
Digestive disorders 263
264 Textbook of Rabbit Medicine

Table 10.3 Properties and dosages of therapeutic agents used in the treatment of enteric disorders of
rabbits

Agent Dose Comments

Prokinetics
Metaclopramide 0.5 mg/kg SC bid Stimulates gastric emptying and GI motility
Cisapride 0.5 mg/kg Oral bid Very effective product in rabbits. Unfortunately, the product has
been withdrawn due to adverse drug interactions in humans.
Contact manufacturers for more information
Narcotic
analgesics
Fentanyl/fluanisone 0.2–0.3 ml/kg IM Provides analgesia to treat abdominal pain that accompanies
(single dose) digestive disorders and gas distension of the viscera.
Fentanyl/fluanisone is a good sedative to clean uneaten
caecotrophs from the perineum
Buprenorphine 0.03 mg/kg SC bid Buprenorphine provides analgesia without marked sedation. It is
less potent but longer acting than fentanyl/fluanisone
NSAIDs
Carprofen 3 mg/kg NSAIDs are used to treat abdominal [Link] is a weak
cyclo-oxygenase inhibitor and does not interfere with
Meloxicam 100 µg (1 drop)/kg prostaglandin synthesis as much as other NSAIDs. Prostaglandins
(ketoprofen or sid stimulate soft faeces production
flunixin can also be
used)
Anti-ulcer drugs
Ranitidene 2 mg/kg IV or In rabbits, gastric ulceration occurs in conjunction with stress and
5 mg/kg PO GI hypomotility
In other species gastric ulceration can be associated with NSAID
therapy
Antibiotics
Trimethoprim/sulpha 40 mg/kg Oral bid Safe antibiotic orally. It can be used against enteric pathogens
such as E. coli. Also effective against coccidia
Metronidazole 40 mg/kg Oral bid Metronidazole is effective against Clostridia spp. and has been
cited as a treatment of choice for enterotoxaemia
Cholestyramine 0.5 g/kg bid Binds with enterotoxins
‘Questran’ Can be used to treat enterotoxaemia
Can be used prophylactically in situations where enterotoxaemia
may develop
Liquid paraffin 1–2 ml/kg bid Softens impacted gastric or caecal contents
Probiotics As directed May be useful either prophylactically or therapeutically to
encourage a healthy gut flora
Inactivated by concurrent oral antibiotic therapy
Fluid therapy
Oral (Lectade) Approximately Oral fluids help to soften impacted stomach contents in addition
10 ml/kg every to providing water and electrolytes
2–3 h
Subcutaneous 10 ml/kg Subcutaneous fluids can be used in animals that are not
(5% glucose or dehydrated although intravenous therapy is preferable for
Hartmann’s solution) dehydrated patients with poor tissue perfusion
Intravenous 10–15 ml/kg/h Immediate PCV, glucose, urea and electrolyte assay is
advantageous. An I-stat analyser (Heska) is a very useful piece of
equipment
Stress can cause oliguria in rabbits
0.2–0.3 ml/kg i.m. fentanyl/fluanisone (Hypnorm, Jannsen)
provides sedation and analgesia that reduce stress levels and
facilitates intravenous fluid therapy
Nutritional Good quality hay, Hay/grass provides indigestible fibre that stimulates gut motility
support fresh grass and
• Hay palatable foods Dandelions, curly kale, spring greens and grated carrot will tempt
• Grass should be most rabbits
• Tempting food available
ad lib. continued
 Digestive disorders 265

• Baby foods 10 ml/kg liquidized Liquidized or cereal baby foods supply carbohydrates that are
food every 2–3 h absorbed from the small intestine as an instant energy source
that prevents mobilization of free fatty acids from adipose tissue
and development of hepatic lipidosis
• Extruded Can be ground up Ground up fibre (i.e. small enough to go through a syringe)
complete food or mashed provides substrate for caecal bacteria but does not affect gut
(Burgess Ad lib motility
Suparabbit Excel)
Vitamin C 50–100 mg/kg Vitamin C reserves are depleted in times of stress
Anabolic steroids 2 mg/kg Anabolic steroids may stimulate appetite
(nandrolone)
Corticosteroids
Prednisolone 0.5–2 mg/kg PO, Long-term use may be indicated in chronic diarrhoea (not
IM, SC uneaten caecotrophs) that could be immune mediated
Dexamethasone 1–3 mg/kg IM, IV Single injections may be of use to counteract shock in cases of
Betamethasone 0.1 mg/kg IV acute enterotoxaemia

Abbreviations: sid: once daily; bid: twice daily; IM: intramuscular injection; IV: intravenous injection; PO: orally;
SC: subcutaneous injection.

be insidious and anorexic rabbits are often In contrast, some rabbits show hypergly-
reasonably alert in the early stages. A caemia in the early stages of the disease
reduced appetite and a reduction in faecal associated with stress or pain. A blood
output are the early warning signs (Table 3.1). glucose value within the normal reference
As the disease progresses, the rabbit becomes range is reassuring. A PCV in excess of
totally inappetant and depressed. It adopts a 40–45% indicates dehydration. Prerenal
hunched appearance and may sit for hours, azotaemia is common in rabbits with
immobile in the corner of the cage or hutch. gastrointestinal stasis. It is found in conjunc-
Affected rabbits do not groom and appear to tion with dehydration. Blood urea and creati-
be oblivious to their surroundings. They are nine levels can be markedly elevated. If the
no longer inquisitive and do not respond to analytical equipment is available, electrolyte
being spoken to or the offer of an interesting status is invaluable. Once hepatic lipidosis is
titbit. The rabbit becomes clinically established, fatty infiltration of the kidneys
dehydrated. There are no specific clinical occurs and the rabbit goes into liver and
signs associated with the development of kidney failure. There can be a range of bizarre
hepatic lipidosis but affected animals are biochemistry results at this stage.
depressed and unresponsive. In the terminal Treatment of gastrointestinal hypomotility is
stages, they become totally inappetant and aimed at restoring appetite, correcting
are often disorientated and ataxic. Hypergly- electrolyte imbalances, correcting dehydration,
caemia occurs. Death is due to liver and stimulating gastric emptying, promoting
kidney failure. normal gastrointestinal motility and softening
Diagnosis of gastrointestinal hypomotility and lubricating impacted food and hair. The
can be made on clinical history and examina- medical treatment of gastrointestinal
tion. It can be confirmed by radiography (see hypomotility and the properties of therapeutic
Box 10.1 and Figures 10.3 and 10.5). Faecal agents are summarized in Tables 10.2 and 10.3.
output ceases completely and the impacted The general treatment of digestive disorders is
stomach can often be palpated as a hard mass given in Box 10.3. Nutritional support is impor-
behind the ribs, especially in the later stages tant to prevent the development of hepatic
of the disease. A blood sample can aid differ- lipidosis. Analgesics are always indicated, as
ential diagnosis, assist with choice of fluid gas accumulates in stagnant sections of the
therapy and offer prognostic indicators. A gastrointestinal tract, causing distension and
lipaemic sample or the presence of hypergly- pain, which compound the situation further.
caemia in conjunction with ataxia is a poor Diet is a key part of the treatment of
prognostic sign. In the early stages, hypogly- gastrointestinal hypomotility and nutritional
caemia may be found. This is treated by oral, support will prevent the development of
subcutaneous or intravenous glucose therapy. hepatic lipidosis. All anorexic rabbits must be
266 Textbook of Rabbit Medicine

Box 10.3 General principles of treatment of digestive disorders in rabbits

Treatment of digestive disease in rabbits is • Oral, subcutaneous or intravenous glucose

aimed at treating and removing the underly- is indicated in rabbits that are known to be
ing cause, preventing dehydration and hypoglycaemic from blood glucose
electrolyte imbalances, maintaining or measurements
restoring gut motility, protecting normal gut • Analgesia is essential to treat the pain that
flora and preventing hepatic lipidosis. The is associated with colic or gas distension
dosages and properties of therapeutic of the bowel
agents are summarized in Table 10.3. • There is a risk of gastric ulceration in
anorexic rabbits and anti-ulcer therapy is
• Hospitalization is often necessary to indicated, especially in rabbits that have
permit observation of appetite and faecal been anorexic for more than 48 h
output. Many rabbits with digestive disor- • Motility stimulants are indicated in the
ders require fluid therapy, syringe feeding treatment of motility disorders. They are
and medication by injection an essential part of treatment for gastric
• A healthy rabbit passes copious quantities stasis and can also be used to treat caecal
of hard faecal pellets. Up to 180 pellets a impaction and mucoid enteropathy
day can be passed by a rabbit that is • Antibiotics may be indicated for the treat-
eating well and on a high fibrous diet. ment of enterotoxaemia and in some types
Hard faeces are always passed overnight of diarrhoea. Enrofloxacin, trimethoprim
by a healthy rabbit. The absence of hard preparations or metronidazole are the
faeces is a significant finding least likely to cause disturbances in the gut
• Small faeces, diarrhoea, uneaten or abnor- flora. Metronidazole has been cited as a
mal caecotrophs are easier to monitor in treatment of choice for enterotoxaemia
the hospitalized rabbit caused by Clostridium spiriforme (Carman,
• Rabbits with diarrhoea should not be 1994). Trimethoprim combinations can be
fasted like a dog or cat used to treat coccidiosis
• Indigestible fibre is always required by all • Some rabbits may be malnourished due to
rabbits at all times and can be provided by poor diet or dental disease and the inclu-
a bed of good quality, palatable hay sion of a vitamin supplement in the treat-
• Fresh grass will tempt many rabbits to eat ment protocol can be beneficial. Although
and is a good source of both indigestible rabbits synthesize vitamin C, there is
and digestible (fermentable) fibre evidence that vitamin C requirements of
• Tempting fibrous vegetables can be rabbits increase during periods of stress
offered to rabbits with diarrhoea, although when plasma ascorbic acid has been
dandelions, fruit, lettuce and other salad shown to decrease significantly (Verde and
items should be avoided Piquer, 1986)
• Anorexic rabbits can be offered a selection • Anabolic steroids can be effective as an
of fresh, appetizing leafy green foods. appetite stimulant for rabbits and have
Even rabbits that do not normally eat some beneficial effect in the retention of
greens can safely be offered freshly picked electrolytes. There appear to be no
grass, dandelions, spring greens, cabbage, adverse effects at low doses
kale, carrots or apple • A probiotic can be used to introduce
• Syringe feeding is necessary for rabbits beneficial bacteria to the hindgut. There
that have not eaten for more than 24 h are many anecdotal reports of the efficacy
• Fluid therapy is an essential part of treat- of commercial probiotic preparations
ment for anorexic or diarrhoeic patients. although they contain lactobacillus that is
Oral or subcutaneous fluids can be given not a normal inhabitant of the rabbit gut.
to rabbits that are not dehydrated but Alternatively, caecotrophs collected from a
intravenous or intraosseous therapy is healthy rabbit can be used to introduce
essential in advances cases. Fluid therapy normal bacterial flora
is described in Chapter 4. The safest • Rabbits with digestive disorders are at risk
choice of fluid for most conditions in of developing enterotoxaemia. Cholestyra-
rabbits is lactated Ringer’s or Hartmann’s mine (Questran), an ion exchange resin,
solution can be given to absorb enterotoxins.
 Digestive disorders 267

encouraged to eat. Hepatic lipidosis can concluded that none of the enzyme treatments
develop in any rabbit that becomes anorexic, exhibited any ability to dissolve hair. The
although the risk is greater in obese, pregnant success of pineapple juice as a remedy for
or lactating animals. Tempting foods such as gastric stasis might be due to the introduction
fresh grass, dandelions and appetizing of liquid into the stomach that softens the
vegetables such as curly kale, spring greens, hairball and aids its passage out of the
carrots and apples should be offered. Good stomach. Liquid paraffin can be used to soften
quality hay is important, both to stimulate and lubricate impacted stomach contents.
appetite and to provide a sense of security to Motility stimulants are effective in promot-
reduce stress levels. A bed of hay smells ing gastrointestinal motility. Cisapride is a
familiar. Grass and hay provide long particles very effective remedy for gastrointestinal
of indigestible fibre that are important to hypomotility but, at the time of writing
stimulate gut motility. A quiet environment (October, 2000) adverse drug interactions in
away from predators and barking dogs is humans have led to its withdrawal and the
important. In the initial stages (less than 24 h), agent is difficult to obtain (see Section 4.7.1).
analgesia and the provision of palatable fibre Metoclopramide is an alternative therapy but
can be sufficient to stimulate gut motility and appears to be less effective than cisapride.
prevent progression of the disease. In the Atropine and opioid analgesics can antago-
later stages (more than 24 h without food), nize the effects of metoclopramide. There is in
syringe feeding is required to provide calories vitro evidence that metoclopramide is only
and fluid to soften and lubricate impacted effective in adult rabbits (see Section 4.7).
stomach contents and provide water and Fluid therapy is always indicated in rabbits
electrolytes. Pureed vegetables or baby foods in the later stages of gastrointestinal
provide an easily assimilated digestible hypomotility. Oral or subcutaneous fluids
energy source that can be given through a might be sufficient if the rabbit is not clini-
syringe. A source of fermentable fibre is cally dehydrated but intravenous therapy or
important to provide nutrients for caecal intraosseous fluid therapy is essential once
bacteria. Indigestible fibre cannot be adminis- dehydration becomes evident.
tered through a syringe because the large
particles clog the nozzle. There is no point in
attempting to grind indigestible fibre down 10.4 Gastric ulceration
for syringe feeding in an attempt to stimulate
gut motility. Grinding fibre to a particle size Gastric ulcers are a common post-mortem
where it no longer clogs a syringe means that finding in rabbits, especially in those that
the particles are small enough to be moved have been anorexic prior to death. In a survey
into the caecum instead of the colon and the of 1000 post-mortem examinations by Hinton
stimulatory action on the gut is lost. Nasogas- (1980), 7.3% were found to have ulceration of
tric tube feeding may be necessary as a last the gastric mucosa. The majority of the ulcers
resort for intractable cases, but nasogastric were found in the fundic area of the stomach
tubes can be counterproductive. They clog up and did not exhibit significant tissue reaction
easily and an Elizabethan collar is required. suggesting that the lesions had developed
Elizabethan collars have been proven to be rapidly and were associated with the stress of
stressful to rabbits (Knudtzon, 1988). the associated illness. In 2% of the rabbits, the
Pineapple juice or proteolytic enzymes have ulcers were in the pyloric area and the major-
been recommended as remedies for hairballs ity of these had perforated the mucosa. Many
because they are reputed to dissolve hair. of the pyloric ulcers were found in female
Gillett et al. (1983) conducted an experiment in rabbits that had died in the perinatal period.
which they incubated rabbit hair for up to 3 Experimental stress ulcers can be induced in
days either in papaya, proteolytic enzymes or the gastric mucosa of laboratory rabbits by
pineapple juice. The pH of the solution was administering intraperitoneal injections of
adjusted to 2 with hydrochloric acid to mimic adrenaline (Behara et al., 1980).
conditions in the rabbit stomach. They found Rabbits are unable to vomit and therefore
no difference between the treated and gastritis is more difficult to recognize than in
untreated control samples and the authors the dog or cat. There are no specific clinical
268 Textbook of Rabbit Medicine

Key points 10.2

signs associated with gastric ulceration and
• For many years, the presence of impacted inappetant rabbits are often already in pain
food material and hair within the stomach from other causes. Anthropomorphically, it
was believed to be a cause of anorexia seems likely that gastric ulceration would add
and weight loss. Now, it is recognized to the pain that is already being experienced.
that gastrointestinal hypomotility is the The clinical role of anti-ulcer preparations in
cause of impacted stomach contents the treatment of anorexic rabbits has not been
(trichobezoars or ‘hairballs’) and anorexia evaluated but the possibility of gastric ulcera-
and weight loss are the result tion is a consideration when treating anorexic
• Stimulation of the sympathetic nervous
system inhibits intestinal motility.
rabbits, especially when non-steroidal prepara-
Gastrointestinal hypomotility is associ- tions have been administered. Several human
ated with any stressful situation or preparations may be of use. Rabbits secrete
condition that stimulates the sympa- high levels of gastric acid and pepsin in
thetic nervous system including pain, comparison with dogs, cats, rats and guinea
surgery, stress or fright pigs and the effects of anti-ulcer medications
• A diet high in indigestible fibre stimu- on gastric pH have been investigated (Redfern
lates gut motility and reduces the risk et al., 1991). Although omeprazole (Losec,
of gastrointestinal hypomotility Astra) is theoretically more effective than
• Gastrointestinal hypomotility results in
gas formation in stagnant organs such as
ranitidene (Zantac, GlaxoWellcome) in decreas-
the stomach or caecum. Gas distension ing acid secretion and increasing postprandial
of the viscera is painful and abdominal pH, both preparations have a significant effect
pain stimulates the sympathetic nervous and appear safe as an adjunct to treatment of
system and compounds the situation anorexia. Omeprazole is only available in
• Gastrointestinal hypomotility results in capsule form for humans, which makes it diffi-
anorexia and a fall in glucose absorp- cult to administer a small dose to rabbits.
tion from the stomach and small intes- Ranitidene is available as an oral syrup.
tine. Volatile fatty acid production from
the caecum is also reduced
• Hypoglycaemia stimulates lipolysis and
mobilization of free fatty acids from 10.5 Gastric dilatation and
adipose tissue. Free fatty acids are intestinal obstruction
metabolized as an energy source. Oxida-
tion of free fatty acids releases ketone
bodies that can cause ketoacidosis In pet rabbits, gastric dilatation is caused by
• Accumulation of free fatty acids in the some type of gastrointestinal obstruction.
liver results in the development of Rabbits continually secrete saliva and cannot
hepatic lipidosis. Fatty infiltration of vomit so fluid collects in the stomach, which
other organs, such as the kidney, occurs distends rapidly with fluid if ingesta cannot
and, ultimately, liver and kidney failure
result in death of the rabbit
pass through and down the digestive tract.
• Obese rabbits that already have a fatty Gas is produced which causes further disten-
liver are especially prone to the devel- sion. The stomach and intestine proximal to
opment of hepatic lipidosis the obstruction becomes dilated with fluid
• Increased glucose demand during and gas, giving a typical radiological picture
pregnancy and lactation increases (see Figure 10.5). Typical foreign bodies
susceptibility to hepatic lipidosis during include pellets of impacted ‘felts’ of hair,
periods of anorexia whole dried pulses, pieces of carpet fibre or
• Stimulating gut motility and maintain- other small objects. The small intestine is the
ing a positive energy balance to prevent
oxidation of fatty acids, ketoacidosis
usual site of obstruction although pyloric
and hepatic lipidosis are essential parts obstructions can occur. Rabbits normally
of the treatment protocol for many ingest large amounts of hair during groom-
digestive disorders in rabbits ing, which passes through the digestive tract
• Gastric ulceration is a common post- with no problem. It is felts of impacted,
mortem finding in anorexic rabbits. matted hair that cause obstructions. During
Anti-ulcer treatment, such as ranitidine, moulting, large felts of hair can accumulate,
can be used in rabbits. especially on the plantar aspect of the
 Digestive disorders 269

(a)

Figure 10.5. Lateral view of a rabbit with an

intestinal obstruction.
Figure 10.5(a) shows a lateral view of a two-year-
old Dwarf Lop male rabbit with an acute
intestinal obstruction caused by a felt of ingested
hair. The radiograph shows a grossly distended
stomach containing fluid and gas. There is gas
distension of the small intestine proximal to the site of
obstruction that was in the ileum. This is a characteristic
radiograph. The foreign body was surgically removed
promptly (see Section 10.5.1) and the rabbit made an
uneventful recovery. A differential diagnosis of intestinal
obstruction is mucoid enteropathy, in which gastric
dilatation may be seen in the terminal stages. An
impacted caecum that can be palpated or seen
radiographically is generally associated with mucoid
enteropathy (see Figure 10.9).
Figure 10.5b. Dorsoventral view of a rabbit with
an intestinal obstruction. Figure 10.4 shows the
same rabbit as Figure 10.5. Knowledge of the
topographical anatomy of the intestines aids diagnosis
and location of a foreign body (see Figure 10.2). The
radiographs in Figures 10.5a and 10.5b were taken after
sedating the rabbit with 0.2 mls/kg fentanyl/fluanisone
(see Box 5.5). It is possible to obtain a diagnostic
radiograph by placing a conscious rabbit in ventral
recumbency on an X-ray plate although positioning will
be poor because the hind legs cannot be extended.
Hypnosis and non-manual restraint with sandbags can
be used to obtain a lateral view. A quiet room, gentle
handling and patience are needed. The rabbit can be
kept calm by covering its head with a towel. (b)
270 Textbook of Rabbit Medicine

metatarsus, and can be ingested by the rabbit The typical history of a rabbit with an acute
during grooming. These felts of hair are proximal intestinal obstruction is that the
found more frequently on Angora rabbits and rabbit was well one minute and moribund the
fluffy Dwarf lops, although any breed can be next (see Box 3.3). A feature of the condition
affected. Rabbits with dental problems appear is severe gastric dilatation with fluid and gas,
to be especially prone to intestinal obstruc- which gives the rabbit a bloated appearance.
tion. Rabbits with incisor problems cannot Affected rabbits are totally inappetant,
pull hair out effectively and large mats can depressed and often collapsed. Dehydration
build up before the rabbit can remove them. and an unusual feeling abdomen are evident.
Owners of rabbits with grooming difficulties A distended stomach may be palpable in the
should be advised to watch for these felts and cranial abdomen, especially on the left side.
remove them promptly. Alternatively, the abdomen may be distended
Dried pulses such as locust bean seeds or and tympanic, or feel doughy if intestinal
dried peas or sweet corn can also be exactly rupture has occurred. Electrolyte imbalances
the right diameter to occlude the small intes- cause a variety of symptoms. Twitching,
tine. This type of ingredient should not be blindness and convulsions can occur in the
included in rabbit food. Again, rabbits with terminal stages. Abdominal radiography is
dental problems appear to be prone to usually diagnostic. The hugely distended
swallowing such ingredients whole (Harcourt- stomach can be seen occupying the anterior
Brown and Friggens, 1999). half of the abdomen compromising respira-
Inflammatory lesions or tumours in the tory and circulatory function. Gas shadows
wall of the intestine can cause obstructive can be seen in the small intestine proximal to
disease at any site along the digestive tract, the obstruction (see Figure 10.2).
including the colon. Extramural lesions such Prompt treatment is required for this
as tumours, adhesions, abscesses and painful and stressful condition. Analgesia and
tapeworm cysts in the omentum can cause an prompt decompression of the stomach are
obstruction (see Plate 36). A cystic calculus essential. The stomach can be decompressed
has been reported as a cause of intestinal
blockage (Talbot and Ireton, 1975). The sever-
ity of symptoms and the course of the disease Key points 10.3
are related to the site of the obstruction. • In pet rabbits, gastric dilatation is
Complete occlusion of the small intestine is usually associated with an intestinal
rapid in onset and fatal unless the obstruction obstruction. Mucoid enteropathy can
is removed promptly. Sometimes the foreign also cause gastric dilatation
body can move through the small intestine, • Rabbits with intestinal obstruction are
intermittently obstructing the intestine depressed, inappetant and shocked.
The onset is sudden and the severity of
causing abdominal pain and anorexia that
symptoms depends on the site of the
passes off when the object passes through obstruction
into the colon. The progress of the obstruction • Felts of hair, carpet fibre, dried pulses,
can be monitored radiographically from the such as peas or beans, tumours,
gas shadows in the small intestine. The tapeworm cysts, abdominal abscesses,
ileocaecal valve is a potential site of intestinal intussusceptions and adhesions are
obstruction. Intestinal lymphoma has been among the causes of intestinal obstruc-
found at this site in two cases (Harcourt- tion
Brown, unpublished data), one of which • Motility stimulants are contraindicated
developed an intussusception of the colon in cases of gastric dilatation
• Intestinal obstruction usually requires
into the caecum. Occlusion of the colon shows
surgery that can be successful if
a more protracted course that lasts for days performed promptly
rather than hours. Obstructions of the large • Occasionally, moving foreign bodies
intestine are not caused by ingested foreign will pass through the ileocolic valve into
bodies, as the lumen of the small intestine is the large intestine. Radiography can be
much smaller than that of the colon. Instead used to monitor the progress of moving
tumours, adhesions and impacted caecal foreign bodies by the gas shadows in
contents can obstruct the colon. the intestines.
 Digestive disorders 271

by passing a stomach tube to release the gas The stomach tube can remain in place
and liquid. Frequently the stomach tube throughout surgery. Endotracheal intubation
blocks with hair and has to be emptied and is advisable. If the anaesthetic induction agent
repositioned. In most cases, the intestinal does not contain an analgesic such as
condition is rapidly fatal with death occur- fentanyl/fluanisone, pre-emptive analgesia
ring within 12 h. There is a small chance of a with butorphanol or buprenorphine is also
moving foreign body passing through the required.
small intestine and into the colon. Motility The abdomen is opened with a midline
stimulants may aid this process but can also incision in the region of the umbilicus. In
cause intestinal rupture if the gut is many cases, the small intestine lies just
completely obstructed. Surgery is straightfor- beneath the incision and is easily recognized.
ward and successful if the case is presented It is visibly distended with gas and fluid
early and surgery is performed rapidly. cranial to the obstruction. The topographical
However, there are many potential life-threat- anatomy of the small intestine and its
ening problems associated with enterotomy relationship to other abdominal organs is
in rabbits; high risk anaesthesia, narrow illustrated in Figure 10.5. Once the obstruc-
intestinal lumen, soft friable tissue, small tion is located, the intestinal loop can be
omentum, propensity to develop adhesions, exteriorized and the surrounding tissues
water and electrolyte imbalances, postopera- protected by sterile absorbent material. The
tive ileus, infection and risk of recurrence due intestinal contents are milked away from the
to stenosis of gut. Long-haired rabbits or obstruction before applying bowel clamps or
those with dental problems will still have the asking an assistant to occlude the intestine
predisposing cause even if they survive the with digital pressure. The enterotomy
surgery. Therefore, euthanasia is the most incision is made along the antimesenteric
humane option unless the owners are keen edge of the intestine distal to the foreign body
for surgery, and accept all the risks and to avoid placing sutures in devitalized tissue.
expense that are incurred. The foreign body is removed and any everted
Gastric dilatation is also a feature of mucosa trimmed off before suturing the
mucoid enteropathy. The onset is usually wound with a single layer of appositional
more gradual than dilatation due to an interrupted sutures making sure that they
intestinal obstruction. A palpably, impacted include the submucosa (see Figure 15.1). A
caecum in association with gastric dilatation fine inert, absorbable monofilament suture
is suggestive of mucoid enteropathy. Radiol- material with a high tensile strength is
ogy can be used to differentiate the two required, such as 5/0 poliglecaprone
conditions (see Figures 10.4 and 10.9), (Monocryl) or polydioxanone (PDS II,
although exploratory laparotomy may be Ethicon). The repair of an intestinal incision is
indicated to confirm the diagnosis. difficult due to the small diameter of the
organ and the friability of the tissue. It is
important to avoid stenosis as much as possi-
10.5.1 Surgical removal of ble as it increases the possibility of re-obstruc-
intestinal foreign bodies tion at a later date. If enterectomy is
indicated, the intestine should be sectioned at
Basic surgical principles in rabbits are a slight angle to preserve its antimesenteric
described in Chapter 15. If the rabbit has been vascularity. Although techniques such as
premedicated with low dose (0.2 ml/kg) side-to-side or side-to-end anastomosis can be
fentanyl/fluanisone to obtain the abdominal performed, they have no advantage over an
radiographs, it can subsequently be masked end-to-end anastomosis, which is technically
down with isoflurane to induce anaesthesia simpler (Bouvy and Dupré, 1997). A good
(see Box 5.5). Prior to surgery, blood samples seal to prevent leakage of intestinal contents
should be taken to assess PCV, glucose and is necessary as omentalization is difficult in
electrolyte status before commencing fluid rabbits due to the small omentum. Post-surgi-
therapy. The passage of a stomach tube is cal adhesions to other organs form readily.
required to decompress the stomach and Withholding food postoperatively is not an
remove as much fluid and gas as possible. option in rabbits. Small meals of soft
272 Textbook of Rabbit Medicine

REDUCED APPETITE FOR CAECOTROPHS PHYSIOLOGICAL FACTORS

HIGH PROTEIN DIET CHANGE OF DIET

LOW FIBRE DIET
STRESS
NO RESTRICTION ON FOOD
INTERRUPTION OF
TAINTS FROM PLANTS DAILY ROUTINE
ALTERING ODOUR

UNEATEN
ILLNESS SOFT FLUFFY COAT
FAECES
(CAECOTROPHS) ELIZABETHAN
COLLARS
Interspersed with normal
URINE SCALDING
hard faecal pellets LARGE DEWLAP
DERMATITIS CAUSED BY
UNEATEN CAECOTROPHS ABDOMINAL MASSES
SPONDYLITIS
INFECTED PERINEAL SKIN FOLDS
NEUROLOGICAL
MUSCULOSKELETAL DISEASE e.g. E. cuniculi
PROBLEMS DENTAL DISEASE OBESITY
SMALL CAGE
PAIN ASSOCIATED WITH INGESTION OF PHYSICALLY UNABLE TO REACH
CAECOTROPHS OR GROOM PERINEUM

Figure 10.6. Causes of uneaten caecotrophs that may adhere to fur around anus.

digestable food can be fed for the first few Caecotrophs are produced approximately
days postoperatively to allow the intestine to 4 h after the last meal during quiet periods of
heal. Postoperative analgesia and motility the day or night when the rabbits are at rest.
stimulants are essential. A period without disturbance is required for
ingestion (Lang, 1981). Many pet rabbits
produce caecotrophs during the morning and
10.6 Disorders of caecotrophy if their routine is disturbed, they may deposit
a pile of caecotrophs that are left uneaten.
This phenomenon is sometimes observed in
10.6.1 Normal caecotrophy rabbits that have been admitted for an anaes-
thetic or some other procedure. Soft faeces
Caecotrophy refers to the ingestion of soft may be found in the bottom of their cage or
faeces (caecotrophs) that are clusters of carrier and are not necessarily a cause for
mucus encapsulated pellets of pasty, odorous concern.
material that originates from the caecum. The ingestion of caecotrophs from the anus
Caecotrophs contain bacteria, protozoa, is triggered by stimulation of rectal
yeasts and their fermentation products, which mechanoreceptors and the perception of the
are amino acids, volatile fatty acids, vitamins specific odour of the soft faeces. The odour of
and enzymes such as amylase and lysozyme. the caecotrophs is influenced by the volatile
Caecotrophs are a valuable source of nutri- fatty acids they contain. Germ-free rabbits do
ents to the rabbit. Caecotrophy starts at about not eat their caecotrophs (Lang, 1981).
3 weeks of age and is established by 6 weeks Metabolites and hormones affect the rabbit’s
(Lang, 1981). appetite for caecotrophs (Fekete, 1989). When
 Digestive disorders 273

food is scarce, all caecotrophs are consumed. the rabbit but is not life threatening.
When food is available ad libitum, the amount Diarrhoea results in major disturbances in
of caecotrophs consumed is influenced by the water and electrolyte metabolism and can be
protein and fibre content of the diet. rapidly fatal. Caecotrophs are produced inter-
Increased levels of fibre increase caecotrophy mittently, usually once or twice every 24 h,
whereas high protein levels reduce it. Increas- when the animal is at rest. Copious amounts
ing the indigestible fibre component of the of hard faecal pellets are produced between
diet not only stimulates the rabbit to eat the episodes of soft faeces production and can be
caecotrophs but also makes the pellets firmer seen interspersed with any uneaten soft
and less sticky. Healthy rabbits that eat a high faeces in the bedding or on the floor of the
fibre diet will consume all their caecotroph hutch. Rabbits with enteritis and true
whereas rabbits that are fed ad libitum on low diarrhoea do not produce hard faecal pellets.
fibre cereal diets will often leave caecotrophs Instead, they produce soft faecal material that
uneaten. On some diets, particularly where may be mixed with mucus. Rabbits suffering
certain herbs or legumes are included, the from caecotrophic disorders continue to eat
soft faeces appear less attractive than usual well and produce large numbers of hard
and are not ingested (Lang, 1981). Many faecal pellets. Rabbits with diarrhoea are
diseases alter normal caecotrophic function, usually anorexic and depressed.
either by altering the consistency and compo- Although uneaten caecotrophs are not
sition of the caecotrophs or by interfering directly life threatening, the implications for
with the ingestion of caecotrophs from the the welfare of the individual rabbit are far
anus (see Figure 10.6). reaching. The condition is difficult to treat
Rabbits that do not eat their caecotrophs successfully in the short term and tends to
are deprived of certain vitamins and amino recur. Owners become disillusioned and are
acids that are synthesized by the caecal deterred by the smell and inconvenience of
microflora. The effect of caecotrophy on bathing and cleaning their pet’s perineum.
protein and amino acid metabolism is greater The constant smell and presence of the faecal
in rabbits on a poor diet that is deficient in mass can result in owners abandoning their
amino acids than on a diet with a higher pet, either by releasing it into the wild or by
protein content (Jécsai et al., 1985). leaving it permanently confined to its hutch.
The strong smell of uneaten caecotrophs
attracts bluebottles during the summer
months and affected rabbits are high-risk
10.6.2 Differentiation between candidates for fly strike.
uneaten caecotrophs and
diarrhoea
10.6.3 Physical conditions that
A healthy rabbit on a balanced diet ingests interfere with caecotrophy
caecotrophs straight from the anus without
the owner ever seeing the caecotrophs or Many conditions can stop a rabbit consuming
being aware of their existence. Many condi- caecotrophs. Any skin condition that makes
tions interfere with the ingestion of the perineal area sore and painful has the
caecotrophs (see Figure 10.6). Abnormalities potential to prevent caecotrophy. The volatile
in caecotrophy result in quantities of uneaten fatty acid content of caecotrophs not only
faecal material being deposited on the floor of gives the characteristic odour but also scalds
the hutch or becoming entangled in the fur the skin under the mass of caked faecal
around the anus. The strong characteristic material. The perineum of a rabbit is a very
odour of uneaten caecotrophs and their soft, sensitive area and if the skin is sore, the rabbit
pasty consistency often misleads owners into may be reluctant to groom the area and ingest
believing their rabbit has diarrhoea. So, at the caecotrophs as they arrive at the anus. A
outset of the consultation, it is important to vicious circle is formed, which results in sore,
differentiate between uneaten soft faeces and inflamed infected perineal skin (see Figure
true diarrhoea. Uneaten soft faeces is an 9.1). Rabbits with fast growing, soft, fluffy
unpleasant condition for both the owners and coats can develop large mats of fur around
274 Textbook of Rabbit Medicine

the anus and under the tail. This fluffy coat and granulomatous lesions in the central
texture is impossible for these rabbits to nervous system caused by E. cuniculi are
groom themselves. Soft faeces become entan- possible causes of such deficits.
gled in the fur and can provide a physical
barrier to the anus.
In order to reach the anus and ingest 10.6.4 Consistency of caecotrophs
caecotrophs, the rabbit has to position itself
correctly. Any condition that reduces flexibil- Although softer than hard faeces, caecotrophs
ity or causes immobility can result in uneaten should have a firm pasty consistency.
caecotrophs. This includes restriction in a Uneaten caecotrophs that are soft in consis-
small cage or carrier. Obese rabbits are often
too fat to turn round and reach their
perineum, both to groom or to ingest Key points 10.4
caecotrophs. Loose-skinned individuals often • Caecotrophs have a soft pasty consis-
tency and a strong odour. Many owners
develop large perineal skin folds, especially if
mistake uneaten caecotrophs for
they are overweight. These skin folds can diarrhoea, especially when they adhere
become infected and sore, which makes to the fur around the anus
grooming painful. Faecal material can become • It is important to make the distinction
entrapped in the folds of skin and exacerbate between uneaten caecotrophs and
the problem. Some obese females or even diarrhoea. Diarrhoea is a life-threaten-
castrated males develop huge dewlaps that ing condition in rabbits due to its effects
pose an additional physical barrier to the on water and electrolyte metabolism.
perineum. Rabbits that are fed ad libitum on Uneaten caecotrophs are not life threat-
low fibre diets are not only more likely to ening
• Rabbits that are not ingesting
leave caecotrophs uneaten but are also likely
caecotrophs do not have a reduced
to become fat and lazy. Musculoskeletal appetite and pass normal hard faeces in
conditions that either affect the rabbit’s flexi- addition to uneaten caecotrophs
bility or cause pain when it turns round to • Rabbits with enteritis do not pass hard
reach its anus also interfere with caecotrophy. faecal pellets. They are usually unwell
Spinal deformities such as kyphosis or verte- and inappetant
bral spondylitis are a common radiological • The consistency of caecotrophs can be
finding. Arthritic joints or painful infected soft or liquid and can mimic diarrhoea.
hocks can make a rabbit reluctant to change Change in routine or dietary change
position to clean and groom properly. such as the introduction of salad items
or soft fruit can result in production of
Affected rabbits may not eat caecotrophs from
soft caecotrophs
the anus but will deposit them in the bedding • Several clinical conditions can either
and consume them later or not eat them at all. reduce a rabbit’s appetite for
Dental disease is a common reason for caecotrophs, or prevent a rabbit from
rabbits to leave caecotrophs uneaten and not to consuming caecotrophs from the anus
groom their perineal area. Sometimes caecotro- • Uneaten caecotrophs can become
phy abruptly ceases when sharp hooks develop entangled in the fur around the anus
on the cheek teeth and lacerate the tongue as and cause a superficial pyoderma in the
the rabbit attempts to lick and groom. In other skin beneath
cases, incisor malocclusion prevents the rabbit • Treatment of uneaten caecotrophs is
aimed at identifying and treating the
from picking up and consuming caecotrophs.
underlying cause, clearing up any skin
Any condition that reduces appetite also infection, improving the rabbit’s
reduces the appetite for caecotrophs, so appetite for caecotrophs and improving
almost any condition that makes a rabbit their consistency so they are not so
unwell can result in uneaten caecotrophs. sticky
Neurological diseases, that affect either the • Decreasing dietary protein and increas-
sense of smell or the neural pathways that ing dietary fibre increase the rabbit’s
supply the rectal mechanoreceptors, may appetite for caecotrophs
interfere with caecotrophy. Degenerative disc • Increasing dietary fibre also results in
disease, lumbosacral dislocations or fractures, caecotrophs of a firmer consistency.
 Digestive disorders 275

Box 10.4 Treatment of uneaten caecotrophs and perineal soiling

Rabbits with ‘sticky bottoms’ can be a altogether. Vegetables, but not fruit may
challenge to treat successfully. The first step be offered, introducing one new item
is to clean and treat the soiled perineum. The every few days starting with the more
next step is to identify and treat the under- fibrous varieties such as spring cabbage or
lying cause (see Figure 10.6). broccoli. Apples, carrots and garden
weeds such as dandelions can be intro-
In the short term duced later. Soft fruit and salad items such
• Soiled fur should be carefully clipped us cucumber, lettuce and tomatoes are not
away from the perineum. Simply bathing necessary and should be avoided
the area can be counterproductive as it altogether in rabbits that have a tendency
leaves the fur soiled and damp and leads to not to eat soft caecotrophs
to infection of the underlying skin • The introduction of fibrous green foods
• If the skin is inflamed, analgesia is and vegetables is beneficial in increasing
indicated. Analgesics can also bring about the fibre content and reducing the calorie
a temporary respite from caecotroph content of the diet. In the short term, the
production that is beneficial. Non-steroidal introduction of new foods can unbalance
analgesics reduce caecotroph production the caecal flora, alter the consistency of
by inhibiting endogenous prostaglandin the soft faeces, and compound the
synthesis (Pairet et al., 1986). Meloxicam problem. Therefore, dietary modification
or ketoprofen have a greater influence on should take place gradually
prostaglandin production than carprofen. • Obesity is one of the main causes of
Soft faeces production also appears to be perineal soiling and weight reduction is an
temporarily reduced after sedation with essential part of the treatment (see
narcotic analgesics, especially fentanyl/ Chapter 2). Exercise is also important
fluanisone (Hypnorm, Janssen) • Weight reduction and dietary modification
• Analgesics also alleviate pain from spinal may only be partially effective in resolving
problems or arthritis, which may be the problem in rabbits that have deep
preventing a rabbit from grooming and perineal folds. In obese animals, the skin
cleaning the perineal region folds often persist after the rabbit has lost
• Systemic antibiotics do not improve the weight. Surgical removal of the skin folds
consistency or reduce the production of soft is a simple and effective remedy.
faeces, although they may be beneficial in
treating the perineal dermatitis. A ‘safe’ Long-term management of incurable cases
antibiotic such as enrofloxacin or trimetho- of perineal soiling
prim that is unlikely to cause antibiotic- In some cases of perineal soiling, the under-
associated diarrhoea should be selected lying cause cannot be removed and the
• In the early stages, plenty of good quality owner will have to manage the problem for
hay or grass is required. Grass is ideal as the lifetime of the rabbit. Other steps may be
it contains a mixture of fermentable and needed, in addition to modifying the diet to
indigestible fibre and is palatable to most alter the consistency of caecotrophs.
rabbits. A gradual dietary change will be • Fluffy coated breeds require constant
required in the long term grooming and clipping in the area around
• Probiotics may play a part in establishing the tail and genitalia to prevent the hair
a healthy caecal microflora. becoming long and forming mats. Rabbits
with maloccluded or no incisors require
In the long term regular grooming in that area
• Dietary modification is of paramount • Enough space is required for the rabbit to
importance in altering the consistency of move away from soiled bedding and
the caecotrophs and stimulating the decrease the likelihood of caecotrophs
rabbit’s appetite for them sticking to the fur
• Increasing the amount of fibre in the diet • Caecotroph production follows a circadian
and reducing the amount of high calorie rhythm. Caecotrophs are usually produced
treats and cereals increases the rabbit’s during the morning. Observation of the
appetite for caecotrophs and makes them individual rabbit’s excretion pattern and
more fibrous and less sticky changing the bedding accordingly can
• Cereal mixtures should be reduced or minimize soiling of the fur
withdrawn and substituted with small • Long-term NSAID analgesic therapy may
amounts of complete rations. Treat foods be helpful in the treatment of underlying
such as chocolate should be cut out spondylitic or arthritic conditions.
276 Textbook of Rabbit Medicine

Figure 10.7. Lateral view of the abdomen of a rabbit with an impacted caecum.
This radiograph was taken with the rabbit conscious. Gas has collected within the caecum
and outlines several large pieces of impacted caecal material. Further impacted material can
be seen in the caudoventral abdomen. In some cases, hard pieces of impacted material
(caecoliths) can obstruct the colon as they are moved into the large intestine (see Figure
10.8). Like gastric impaction, impaction of the caecum can be the result of stress. The rabbit
had recently been abandoned and, as a result, was subjected to the additional stresses of
transport and rehoming. In this case, treatment was successful (see Section 10.7).

tency are more likely to become entangled in the caecum. Most sources of fibre are a
the fur under the tail, rather than drop into mixture of fermentable and indigestible fibre
the bedding. Therefore changing the texture so increasing the overall fibre content of the
of the caecotrophs so that they are firmer is diet is likely to increase the amount of
beneficial for both the rabbit and its owner. fermentable fibre that reaches the caecum.
Caecotrophs have a higher protein and Increasing dietary fibre also increases
water content and lower fibre content than appetite for caecotrophs and the amount of
hard faecal pellets. The amount and consis- soft faeces that are produced (Carabaõ and
tency of caecotrophs is affected by the fibre Piquer, 1998).
content of the diet. The type of fibre is impor- The consistency of soft faeces is also influ-
tant. Increasing the amount of indigestible enced by the water content. Water is absorbed
fibre in the diet does not affect the volume or from soft faeces during their passage through
consistency of soft faeces because long fibre the colon and variations in transit time can
particles do not enter the caecum (Fraga et al., lead to changes in consistency in soft faeces.
1991; Garcia et al., 1995). Increasing the The introduction of novel foods, especially
fermentable fibre content of the diet does succulent items such as lettuce or fruit can
have an effect on caecotroph consistency alter the consistency of caecotrophs so they
because small fibre particles are moved into are more liquid. This transitory change could
 Digestive disorders 277

be due to alterations in the transit time or Caecal impaction is difficult to treat.

changes in the caecal microflora. Dietary Surgery is unlikely to be successful. Medical
starch levels have no effect on the chemical treatment is directed at providing nutrition,
composition of caecal contents or on the relieving pain, promoting gastrointestinal
composition of hard or soft faeces (Carabaõ et motility, softening the caecal contents and
al., 1988). promoting caecal evacuation. Fluid therapy by
The approach to treatment of uneaten all routes, intravenous, subcutaneous and oral
caecotrophs is summarized in Box 10.4. In the is indicated, plus liquid paraffin. All those
short term, treatment is directed at clipping foods that are reputed to cause ‘diarrhoea’
and cleaning the perineum and identifying such as lettuce or fruit may tempt an
the cause of uneaten caecotrophs. In the long inappetant rabbit to eat and provide
term, dietary modification and weight reduc- additional fluid in addition to stimulating
tion are required. intestinal motility. As in all gastroenteric
conditions in rabbits, good quality hay or
fresh grass must be constantly available as a
10.7 Caecal impaction source of indigestible fibre. Motility stimu-
lants such as cisapride and metaclopramide
The cause of caecal impaction in rabbits is not can be useful in stimulating motility, although
always clear. Dry, impacted caecal contents in their effect on caecal motility in rabbits is not
conjunction with mucus production in the clear. Sometimes, motility stimulants appear
colon is a feature of mucoid enteropathy, to cause stomach cramps perhaps due to their
which is more often encountered in the effects on the impacted organ. Analgesics are
juvenile rabbit than the adult. In the adult pet indicated although, theoretically, interference
rabbit, caecal impaction occurs sporadically. with prostaglandin production by non-
Like gastric stasis, there is often a history of steroidal analgesics could have an inhibitory
a stressful situation (see Figure 10.7). effect on the fusus coli. Carprofen is a weak
Dehydration may play a part in the cyclo-oxygenase inhibitor and therefore has
aetiopathogenesis. It is known that feeding less effect on prostaglandin production than
small fibre particles that absorb water can some other NSAIDs. Non-steroidal analgesic
cause caecal impaction. Bulk laxatives, such therapy could contribute to gastric ulceration,
as methylcellulose or psyllium are examples. which is often a post-mortem feature of
Ground up lignified material can have a anorexic rabbits, and anti-ulcer treatment with
similar effect. Small particles, such as clay cat ranitidene or omeprazole is indicated.
litter can also become impacted as they are Experimentally, prostaglandin administra-
moved into the caecum during mixing and tion is followed by the passage of soft faeces
separation of ingesta in the proximal colon. (Pairet et al., 1986). The author has used
The onset of caecal impaction can be insid- prostaglandin therapy (0.2 mg/kg dinoprost)
ious. In the initial stages, the rabbit may not as a last resort on a small number (3) of
look particularly unwell, but is inappetant rabbits with impacted caeca. The caecal
and loses weight. The condition may be contents had been softened by orally admin-
mistaken for dental disease as the rabbits may istered liquid paraffin for 24–36 h prior to
pick at food, eat a little and then drop it prostaglandin treatment. In all cases, the
uneaten. Affected rabbits adopt a hunched impacted caecal contents were evacuated
stance. Faecal output is reduced or absent. 24–48 h after prostaglandin administration.
There is often mucus production. The All the rabbits went on to make a full recov-
impacted organ can usually be palpated as a ery although they appeared to be in some
hard sausage-shaped structure in the ventral abdominal discomfort for a few hours after
abdomen that can be seen on abdominal the injection. However, prostaglandins have a
radiographs. On post-mortem examination, the number of systemic effects and the decision
caecal contents are solid and dry. Occasion- to use them should not be taken lightly.
ally, a large lump of hard dry caecal contents Concurrent oral and parenteral fluid therapy
can move into the colon and cause an obstruc- and analgesia are necessary. There might be
tion. Caecal dilatation may be the result (see adverse effects associated with the use of
Figure 10.8). prostaglandins in rabbits.
278 Textbook of Rabbit Medicine

Figure 10.8. Lateral radiograph of a rabbit with caecal and intestinal tympany in
association with chronic diarrhoea. The figure shows a lateral view of the abdomen of a
4-year-old neutered male rabbit that suffered from periodic bouts of anorexia and abdominal
distension. In the interim, the rabbit had a good appetite but suffered from chronic diarrhoea.
The stools were voluminous and contained a mixture of indigestible fibre particles and
bacteria. Hard and soft faeces were indistinguishable. The rabbit was fed on a high fibre diet
consisting of mainly grass hay with a small amount of good quality mixed ration. Vegetables
appeared to exacerbate the problem. Blood samples showed a mild anaemia and
hypoproteinaemia. Bouts of tympany responded to treatment with analgesics and oral
trimethoprim/sulpha combinations. The rabbit was eventually euthanased. Post-mortem
examination revealed a large (2–3 times normal size) flaccid caecum. Histopathological
examination of the caecum and intestines showed lymphoplasmacytic enterotyphlocolitis
suggestive of an immune-mediated aetiology. The author has seen several similar cases in
which dietary modification and oral prednisolone has been prescribed, in addition to other
treatment, with a limited degree of success.
A similar radiological picture can be seen in cases of caecal obstruction, which results in
gas distension of the caecum. The cause of the obstruction is usually a large impacted lump
of caecal material (caecolith) or a neoplasm such as a lymphoma. The cause of the
obstruction can sometimes be seen radiographically or ultrasonagraphically. In cases of caecal
obstruction, there is not the history of large loose voluminous faeces in association with a
good appetite.

10.8 Dysautonomia hares, horses (grass sickness) and cats (Key-

Gaskell syndrome). The disease mainly
Dysautonomia is a dysfunction of the affects the digestive tract and is characterized
autonomic nervous system that results in loss by reduced gut motility, although other signs
of sympathetic and parasympathetic function. associated with loss of autonomic function,
Dysautonomias have been described in dogs, such as mydriasis, urine retention or dry
 Digestive disorders 279

mucous membranes, may also be evident. suffering from mucoid enteropathy (Whitwell
Histopathological changes are seen in the and Needham, 1996). Histology of the ganglia
autonomic ganglia. Chromatolysis-like showed chromatolysis-like degenerative
degenerative changes take place in the changes in many neurons and some neuronal
neurons. Dysautonomic disease is well vacuolation. In 1997, Boucher and Nouvelle,
documented in the dog, cat and horse in in an outbreak of mucoid enteropathy,
which loss of autonomic function carries a described clinical signs which were similar to
poor prognosis although the occasional mild dysautonomic disease in horses and cats, i.e.
case can survive with careful nursing. In mydriasis, dry mucous membranes, reduced
recent years, dysautonomia has been tear production, bradycardia (less than
described in rabbits suffering from mucoid 100 bpm), urine retention and intestinal
enteropathy. impaction. They described an age predisposi-
Cheeke (1987) observed that a strain of tion of 6–8 weeks and the presence of oppor-
non-albino white rabbits with pigmented eyes tunistic pathogens such as coccidia,
were particularly susceptible to diarrhoea Clostridium spiriforme and Clostridium perfrin-
and that evidence of ‘insufficient nerve gens. Histological examination of the coeliac
ganglia in the intestine’ was seen. An analogy and mesenteric ganglia revealed characteris-
with grass sickness in the horse was made. tic lesions similar to dysautonomia in other
The discovery of degenerative changes in species.
ganglionic neurons in rabbits suffering from The incidence of dysautonomia or its
mucoid enteritis had been made as early as importance in the syndrome of mucoid
1967, but was not investigated further, enteropathy is not clear at the present time.
although a syndrome of caecal impaction in Mucoid enteropathy is not invariably linked
conjunction with pulmonary oedema and with chromatolysis-like degenerative changes
urine retention was described by several in the neurons. Detailed post-mortem examina-
authors (Van der Hage and Dorrestein, 1996). tion is required to confirm the diagnosis of
In 1991, post-mortem examination of two sick dysautonomia, which can be expensive. Most
hares found on an English estate where cases of mucoid enteropathy are not presented
horses had died from grass sickness revealed to veterinary surgeons for treatment and there
changes in the ganglia and alimentary tract is a great deal of confusion among rabbit
that were remarkably similar to those seen in breeders about the condition. ‘Mucoid
grass sickness (Whitwell, 1991; Griffiths and enteropathy’ is a term that is used in a non-
Whitwell, 1993). In 1996, Van der Hage and specific manner to describe a number of inter-
Dorrestein described the clinical findings, related enteric diseases that occur in rabbits,
pathological lesions and microscopic and especially around the time of weaning. Rabbit
transmission electron microscopic features of breeders will often cull and dispose of ill
the coeliac ganglia of 19 rabbits with mucoid animals themselves. Caecal impaction in
enteropathy. Typical cases were selected that connection with pneumonia, and perhaps
had died following a disease characterized by other autonomic signs such as bradycardia,
emaciation, respiratory distress, distended dilated pupils or urine retention, is suggestive
abdomen with a palpable obstipated caecum of dysautonomic disease. A feature of
or a distended bladder. Degenerative confirmed cases in the UK has been the
changes, manifested as chromatolysis, were presence of an inhalation pneumonia as
found in the coeliac ganglia. No viruses, affected rabbits have problems swallowing
infectious agents, aflatoxins or other causative and may have uneaten food in the mouth and
agents were discovered on food analysis or pharynx (Whitwell, personal communication).
on extensive examination of the liver and Treatment for rabbits with dysautonomia
intestinal contents of affected animals. An follows the same principles as the treatment
analogy was again made with grass sickness of mucoid enteropathy or an impacted
in horses, which is thought to be caused by a caecum. In horses, some mild cases of grass
neurotoxin. sickness can survive with careful nursing and
Dysautonomia was first confirmed in supportive care (Milne, 1997).
rabbits in the UK in 1996 in a colony of The diagnosis of dysautonomia can be
Belgian Hares (which are actually rabbits) confirmed at post-mortem examination, includ-
280 Textbook of Rabbit Medicine

ing histopathology of the autonomic ganglia

and gut wall. The site of the mesenteric
ganglia is illustrated in Figure 16.1 and a
technique for removing autonomic ganglia is
described in Section 17.3.

10.9 Mucoid enteropathy

Mucoid enteropathy is a confusing condition
both in its terminology and in its aetiopatho-
genesis. Many lay people and rabbit breeders
use the terms ‘mucoid enteropathy’, ‘ME’,
‘mucoid enteritis’, ‘mucoid enteritis complex’
interchangeably to describe any enteric condi-
tion of rabbits characterized by diarrhoea,
mucus production, constipation or death.
These signs are non-specific and can be caused
by several diseases. ‘Mucoid enteritis’ has been
the cause of significant losses in commercial
breeding units with reported mortality rates of
approximately 5–10% but rising to over 60%
(McLeod and Katz, 1986). Colibacillosis,
enterotoxaemia, Tyzzer’s disease, coccidiosis
and viral enteritis can all be included in the
syndrome that often affects young rabbits
especially around the time of weaning.
‘Mucoid enteropathy’ is characterized by the Figure 10.9. Ventrodorsal view of a
presence of large amounts of mucus in the rabbit with mucoid enteropathy. The
colon and is usually associated with impaction figure shows a ventrodorsal view of a 4-
of the caecum (see Figure 10.9). Inflammatory month-old, mixed breed, male rabbit
changes are minimal. The terms ‘constipative suffering from mucoid enteropathy. The
mucoid enteropathy’ or CME can also be used stomach is dilated and filled with fluid.
to describe this syndrome. At post-mortem There is gas distension of the duodenum
and jejunum. There is impacted material
examination, the caecum is often impacted
within the caecum that also contains gas.
with dried contents and gas (see Plate 23). The The rabbit died shortly after this radiograph
colon is distended with gelatinous mucus. The was taken. Evidence of dysautonomia was
stomach and small intestine may be distended not found on histopathological examination
with fluid and gas. of the autonomic ganglia and other organs.
The aetiopathogenesis of mucoid enteropa- Note the normal small volume of the
thy is far from clear. It is not known what role thoracic cavity in comparison with the
diet, stress, pathogens, caecal microflora or abdomen.
dysautonomia have in the disease, although it
seems likely that all these factors could have
a part to play. Mucoid enteropathy is a
disease of intensively reared domestic rabbits major role in the development of the disease.
rather than wild ones (Lelkes and Chang, Enzyme deficiencies, infectious agents and
1987). The disease is occasionally encountered enterotoxins have all been cited as other
in adult pet rabbits, especially after a stress- possible causes. Inflammation is not a feature
ful incident such as transport or parturition. of the disease and intestinal hypomotility or
It is known that increasing the amount of changes in the acidity of the caecum have
indigestible fibre in the diet of newly weaned been proposed as aetiological factors (Lelkes
rabbits significantly reduces the incidence of and Chang, 1987). Investigations are often
mucoid enteropathy. Stress appears to play a hampered by the presence of concurrent
 Digestive disorders 281

infections such as coccidiosis, Tyzzer’s sounding guts. There is a disruption of

disease or opportunist pathogens such as normal faeces production. Hard faecal pellets
Clostridia spp. or E. coli. are not produced. Diarrhoea can be present in
A feature of mucoid enteropathy is the the early stages. In the later stages, large
presence of large amounts of mucus in the amounts of mucus, either on its own or mixed
colon. At post-mortem examination, a large plug with faecal material are excreted. Faecal
of mucus is often found obstructing the colon. production may cease completely. Appetite is
In rabbits, mucus production is a response of reduced, sometimes to the point of complete
the hindgut to untoward stimuli (Bergdall and anorexia. Some rabbits are polydypsic
Dysko, 1994) and is not necessarily specific to whereas others may have a reduced water
mucoid enteropathy. Experimentally, ligation intake. A feature of the disease is tooth grind-
of the caecum results in a mucoid enteropathy- ing, presumably due to abdominal pain. A
like syndrome in some rabbits, with large solid impacted caecum may be palpable and
amounts of mucus production in the colon. seen radiographically. Some acute cases
Incorporating the nerves and blood vessels in present with gastric dilatation rather than
the ligature increases the likelihood of inducing caecal impaction. Gas shadows may be seen
a mucus hypersecretion 3–5 days after surgery in the caecum and small intestine. In the
(Hotchkiss and Merritt, 1996a). Surgical terminal stages, there is gastric distension
removal of the caecum does not result in with large amounts of fluid and/or gas in the
mucus production whereas filtrates from the stomach. There may be lung changes. Some
ligated caecum administered to in vitro sections rabbits are presented with respiratory signs.
of colon do stimulate mucus secretion. Injection The disease is progressive and usually fatal.
of oxytetracycline into the ligated caecum In the live animal, differential diagnosis
prevents colonic mucus secretion suggesting includes hepatic coccidiosis and enteritis
that a bacterial secretory product is the stimu- caused by the variety of diseases that affect
lus for excessive goblet cell secretion character- weanling and juvenile rabbits. Intercurrent
istic of mucoid enteropathy. Mucus secretion is disease is common. Confirmation of the
also stimulated in the respiratory tract. Injec- diagnosis is usually made at post-mortem by
tions of cholestyramine into the ligated caecum the presence of large amounts of mucus in the
can prevent the development of mucoid colon.
enteropathy-like symptoms suggesting the Most rabbit breeders do not present cases
presence of some type of toxin (Toofanian and of mucoid enteropathy to veterinary surgeons
Targowski, 1983). for diagnosis and treatment. Affected animals
The caecal microflora of rabbits with exper- are culled or treated with a variety of home
imental mucoid enteropathy induced by caecal remedies. As a result, there is much confusion
ligation is different from that of healthy about the disease and there are claims of
rabbits. There is a decline in the number of success with many different treatments,
gram-positive bacteria, protozoa and large including antibiotics. In most cases, it is not
anaerobic metachromatic bacilli and an clear if the treatments were effective against
increase in gram-negative organisms. The other diseases, such as respiratory or enteric
production of volatile fatty acids also alters pathogens or coccidiosis rather than mucoid
after caecal ligation. In healthy rabbits, acetate enteropathy. In commercial units, affected
predominates followed by butyrate and rabbits are often not treated, although antibi-
proprionate. In experimental mucoid otic therapy can be instigated, either prophy-
enteropathy, caecal acetate and butyrate lactically or therapeutically. Mucoid
concentrations are reduced with an increase in enteropathy is not common in pet rabbits. It
proprionate, isobutyrate, valerate and isovaler- may be seen in the newly acquired baby
ate production (Toofanian and Hamar, 1986). rabbits from the pet shop or breeder, or in an
Typically, growing rabbits are affected by adult stressed by parturition, transport or a
mucoid enteropathy but the disease is change of home. In these circumstances, the
occasionally seen in adults, especially breed- individual rabbit is valuable to the new
ing does. Clinical signs include abdominal owner and treatment is often requested.
distension, subnormal body temperatures, However, the prognosis is poor and most
depression, crouched stance and ‘sloshy’ cases die despite aggressive treatment. Treat-
282 Textbook of Rabbit Medicine

Key points 10.5 • Dysautonomia can be confirmed at

• Caecal impaction occurs in rabbits, post-mortem examination by histo-
either as a clinical entity or as part of pathological examination of the
the syndrome of mucoid enteropathy or autonomic ganglia
dysautonomia. Stress appears to play a • Enteric disease in rabbits is a complex
role in the aetiopathogenesis inter-relationship of infectious and non-
• Feeding small fibre particles that absorb infectious diseases predisposed by poor
water, e.g. bulk laxatives, can cause diet, stress and intensive husbandry.
caecal impaction Rabbit breeders tend to use the term
• Ingestion of clay litter material can ‘mucoid enteropathy’ to encompass any
cause caecal impaction enteric condition that causes diarrhoea,
• The onset of caecal impaction is often mucus excretion, abdominal distension
insidious or death
• The impacted caecum can usually be • Strictly speaking, ‘mucoid enteropathy’
palpated as a hard sausage-shaped is a condition that is characterized by
structure in the ventral abdomen caecal impaction and the presence of
• Analgesia is indicated. Narcotic large amounts of gelatinous mucus in
analgesics such as buprenorphine or the colon. Juvenile rabbits are most
butorphanol may be preferable to susceptible
NSAIDs that inhibit prostaglandin synthe- • Clinical signs include abdominal disten-
sis. Prostaglandins stimulate caecal sion, depression, crouched stance and
emptying. Carprofen is a weak cyclo- ‘sloshy’ sounding guts. Tooth grinding
oxygenase inhibitor and is preferable to is common
other NSAIDs, if a NSAID is required • Disruption of normal faecal output is
• Occasionally, large lumps of impacted one of the first signs of mucoid
caecal material can move into the colon enteropathy. Diarrhoea and/or mucus
and cause an obstruction. The caecum may be seen in the early stages,
dilates with gas. Faecal output ceases followed by cessation of faecal output
and the rabbit becomes depressed and and abdominal distension
anorexic • Despite many investigations, the aetiol-
• Dysautonomia has been identified in ogy of mucoid enteropathy is still not
rabbits. Loss of sympathetic and clear. The syndrome can be reproduced
parasympathetic function results in in laboratory rabbits by ligation of the
reduced gut motility, especially of the caecum
caecum. In the terminal stages, gastric • The prognosis for rabbits with mucoid
dilatation and aspiration pneumonia enteropathy is poor.
can occur

ment is non-specific and follows the same breeding establishments. Intensive, damp,
principles as for other digestive disorders (see dirty conditions predispose to coccidiosis and
Tables 10.2, 10.3 and Box 10.3). Frequent the environment can become heavily contam-
enemas have been recommended (Breit- inated. The disease is caused by a protozoan
weiser, 1997). The role of antibiotics is parasite with a complex life cycle. Wild
unclear, although many breeders believe that rabbits can be affected and, theoretically, are
antibiotics are effective. In advanced cases, a potential source of infection to pet rabbits
euthanasia is the most humane choice. that are fed on grass. Long grass picked by
hand is less likely to be contaminated then
short grass grazed by large numbers of wild
10.10 Enteric diseases caused rabbits.
by specific pathogens The protozoan parasites that cause
coccidiosis are Sporozoa belonging to the
suborder Eimeriorina. Eimeria are parasites of
10.10.1 Coccidiosis epithelial cells. They invade the mucosa of the
intestine, colon and caecum and the epithe-
Coccidiosis is a disease of animals kept in lium of various ducts. Infected rabbits void
crowded conditions and occurs in many oocysts that require oxygen and a period of a
 Digestive disorders 283

several days to become infective. Ingestion of ations and haemorrhages may be seen.
the oocyst releases sporozoites into the Characteristic changes can be seen histologi-
duodenum after the oocyst has been broken cally in the gut wall. During life, oocysts are
down by digestive enzymes. The sporozoites found in the faeces. Sulpha drugs are used to
invade cells and cause tissue damage as they treat coccidiosis. Groups of rabbits can be
complete their complex life cycle ultimately medicated in the food or drinking water. Oral
to release oocysts into the lumen of the gut. trimethoprim preparations can be used to
Eimeria species are host and site specific. treat individual pets. Dose rates are given in
Oocysts can survive for many years in the Table 4.2.
environment but are susceptible to dry condi-
tions. Recovered rabbits become immune to
infection. As many as 14 species of Eimeria [Link] Hepatic coccidiosis
have been described in the rabbit. All but one Hepatic coccidiosis is a serious disease of
species are found in the small intestine, rabbits caused by the species specific Eimeria
caecum or colon and cause ‘intestinal steidae. Wild rabbits can be infected and trans-
coccidiosis’. One species, Eimeria steidae, mission occurs by the ingestion of sporulated
inhabits the epithelial cells of the bile ducts oocysts in food that has been contaminated
and causes ‘hepatic coccidiosis’. There is no by faeces. Sporulation of the oocysts is
cross-immunity between the different Eimeria required for infectivity and requires at least 2
species. days outside the host. Oocysts are extremely
resistant and can remain viable in soil, on
vegetation and fomites for long periods of
[Link] Intestinal coccidiosis time (Harkness and Wagner, 1995). Recently
Eimeria magna and Eimeria irresidua are the voided faeces do not contain oocysts that are
two most pathogenic coccidial species that infective (Harkness, 1997) as a prepatent
affect the intestine of rabbits. Other less period in the presence of oxygen is required
pathogenic intestinal species include E. for development. Eimeria steidae has a slightly
perforans, E. media, E. elongata, E. neoloporis, E. different life cycle to the intestinal Eimeria
intestinalis, E. caecicola and E. piriformis. The spp. Ingested oocysts hatch in the duodenum
developmental stages are restricted to the and sporozoites penetrate the intestinal
ileum and jejunum but, in heavy infestations, mucosa before being transported to the liver,
overspill into the caecum has been observed either in the blood stream, or in macrophages
(Owen, 1992). There are two asexual stages in the lymphatic system. Replication takes
and oocysts appear in the faeces 7–8 days place in the mesenteric lymph nodes before
post-infection. Mixed infections can occur and transport via the hepatic portal circulation to
coccidia are often found in conjunction with the liver where they enter bile duct epithelial
other pathogenic agents such as E. coli. It is cells. Here the life cycle is completed with the
not always clear how important intestinal ultimate release of oocysts into the bile duct.
coccidiosis is during an outbreak of enteritis, The prepatent period lasts for 15–16 days and
although the introduction of a pathogenic oocysts are found in the faeces for at least
species into a susceptible population can 10–14 days after this (Owen, 1992).
prove fatal, especially in young rabbits Clinical symptoms of hepatic coccidiosis
around the time of weaning. Acute infection depend on the severity of infection and on the
causes inappetance, weight loss, depression immune status of the individual. Signs are
and diarrhoea that can be haemorrhagic. associated with the lesions in the liver and bile
Intussusceptions may be associated with ducts, and include weight loss, ascites,
chronic infections. Subclinical coccidiosis jaundice, diarrhoea and hepatomegaly.
results in reduced feed conversion. Weanling rabbits are most commonly affected.
On post-mortem examination, the parasite Post-mortem signs relate to the predilection
can be found on microscopic examination of of the parasite for the bile ducts. There are
intestinal scrapings. Lesions occur primarily pale yellow foci or cords in the liver. The gall
in the ileum and jejunum and are immedi- bladder and bile ducts may be thickened and
ately identifiable by inflammation and distended. The liver is enlarged and fibrotic.
oedema at the site of infection. Mucosal ulcer- The gall bladder is enlarged, distended, and
284 Textbook of Rabbit Medicine

packed with oocysts that can be seen in wet infection. If the rabbit is active and eating
smears of the bile. Impression smears of the well, the prognosis is usually good with
cut surface of the mesenteric lymph nodes or administration of sulpha drugs. Paediatric
liver can reveal all stages of the parasite suspension of trimethoprim/sulfamethoxa-
which is reputed to have nine different zole can be used to treat the individual
schizont stages (Owen, 1992). Remnants of patient (see Table 10.3). A well balanced diet
the disease may be evident in the liver for life is also required as the hepatic coccidiosis
and can occasionally be discovered many interferes with vitamin metabolism.
years later, during post-mortem examination.
Newly weaned animals are most suscepti-
ble and those that recover have a solid life- 10.10.2 Clostridial enterotoxaemia
long immunity. The condition can be treated
with sulpha drugs (Schmidt, 1995). Commer- Enterotoxaemia occurs in rabbits kept in
cial pellets often contain a coccidiostat to colonies and occasionally in the individual pet
prevent clinical disease in rabbit colonies rabbit. The disease is caused by Clostridia spp.
while allowing an immunological response to that are anaerobic gram-positive bacilli
confer immunity. Treatment of established capable of producing powerful enterotoxins.
disease can be problematical, as rabbits that The organisms can reside in the gut without
are not eating well will not be receiving the causing disease but under certain conditions
medication in the feed. In a comparative will rapidly proliferate and cause a severe
study of the response of rabbits infected with enteritis. Clostridium spiroforme is a major
Eimeria steidae to treatment with sulpha- pathogen in rabbit enterotoxaemia, although
quinoxaline, robenidene, methyl benzoquate, Clostridium difficile and Clostridium perfringens
clopidol and a mixture of methyl benzoquate may also be involved (Perkins et al., 1995).
and clopidol, only sulphaquinoxaline and the Pathogenic rabbit strains of C. spiroforme are
combination of methyl benzoquate and clopi- different from non-pathogenic strains in other
dol gave satisfactory control of the parasite species. A similar pathogenic strain has been
(Joyner et al., 1983). Toltrazuril (Baycox, isolated from humans affected with diarrhoea
Bayer) in the drinking water is highly effec- (Carman, 1993). Rabbit isolates of C. spiroforme
tive in reducing oocyst output of intestinal produce a toxin that is neutralized by
and hepatic Eimeria species. A regimen of 2 antiserum to C. perfringens type E iota toxin.
days treatment repeated after 5 days reduces Virtually all rabbit isolates of C. spiroforme are
clinical signs and allows the development of toxigenic, although this is not the case in other
immunity (Peeters and Geeroms, 1986). species. Clostridium difficile produces two
exotoxins, toxin A and B. Toxin A is a lethal
enterotoxin that binds to specific enterorecep-
[Link] Coccidiosis in pet rabbits tors and induces fluid secretion, mucosal
In pet rabbits, coccidiosis is sometimes damage and intestinal inflammation. Toxin B
encountered in the newly acquired young is a potent cytotoxin that interacts synergisti-
rabbit. Intestinal coccidiosis causes cally with toxin A (Perkins et al., 1995).
inappetance, weight loss and chronic In intensive situations, the mortality rate
diarrhoea, which can be blood tinged. from enterotoxaemia can be high due to the
Animals affected with hepatic coccidiosis are prevalence of pathogen in the environment.
often thin, pot-bellied and small for their age. Low fibre, high carbohydrate diets are associ-
Occasionally icterus is seen. Mixed infections ated with enterotoxaemia in commercial
occur. Raised bilirubin values in rabbits of units. Recently weaned rabbits are most
this age are virtually pathognomonic for susceptible. Young rabbits do not digest and
hepatic coccidiosis, especially in conjunction absorb starch as efficiently as adults (De Blas
with other biochemical evidence of liver and Gidenne, 1998) and carry a greater risk of
damage such as a raised AST, ALT, gamma unabsorbed carbohydrate reaching the
GT and alkaline phosphatase values. caecum to act as a bacterial substrate.
Coccidial oocysts may be evident in the Substantial amounts of glucose are required
faeces. By the time the animals are presented by C. spiriforme for toxin production. There is
for treatment they are often recovering from a marked difference in starch digestibility
 Digestive disorders 285

between adult and growing rabbits. In adult bottom of the transport medium where condi-
rabbits, carbohydrate is hydrolysed and tions remain anaerobic. Clostridia spp. concen-
absorbed before it reaches the caecum. trate at the interface of the deposit and
Enterotoxaemia in adult pet rabbits is not supernatant after centrifugation of caecal
associated with a high carbohydrate diet but contents and may be seen on a gram stain
usually follows a disruption of the gut flora from material taken from this area. Toxin is
by antibiotics, other pathogens, toxins or also present in the supernatant but requires
stress. Experimentally, enterotoxaemia can be specialized tests such as the guinea pig
induced by oral administration of dermonecrosis or the mouse lethality assay
clindamycin. The accidental inclusion of for detection (Delong and Manning, 1994).
lincomycin in the diet of commercial rabbits Treatment of enterotoxaemia is not usually
has resulted in clinical outbreaks. successful. Most cases are presented dead or
Enterotoxaemia is manifested by brown, dying. Prompt, intravenous fluid therapy and
watery diarrhoea, collapse or sudden death. supportive care are necessary. Antibiotics and
It is an acute disease although it is sometimes short-acting corticosteroids might be of value.
preceded by a short period of anorexia. In Metronidazole is indicated to kill anaerobic
most cases, enterotoxaemia is rapidly fatal Clostridia spp. Antibiotics such as ampicillin,
due to toxaemia, dehydration and electrolyte clindamycin, lincomycin, amoxycillin,
loss although the occasional case can recover. penicillin or erythromycin that are known to
Peracute cases may be found dead with no precipitate enterotoxaemia should be
prior evidence of disease. Others are found avoided. There is evidence that the ion
moribund, often with liquid tarry brown exchange resin cholestyramine absorbs the
diarrhoea. Chronic cases are manifested by enterotoxin and improves survival rate if it is
anorexia and weight loss and intermittent given in the early stages (see Section 4.9.2).
diarrhoea (Carman and Evans, 1984). This preparation is safe enough to give to
At post-mortem examination, the rabbits are rabbits in any situations where enterotox-
often in good bodily condition but may have aemia could develop. Probiotics can also be
liquid faeces oozing from the anus and stain- administered, although it is not known if they
ing the perineum and hind legs. Typical post- are effective.
mortem findings include inflammation and Vaccination protects sheep from clostridial
hypereamia of the caecum. The small intestine enterotoxaemia and there are anecdotal
or proximal colon can also be affected. Exten- reports from breeders that vaccinating rabbits
sive petechial or ecchymotic haemorrhages on with sheep vaccine reduces mortality rates in
the serosal surface of the caecum are charac- colonies of rabbits that have experienced
teristic of enterotoxaemia. The caecal contents losses from clostridial infections. Clostridial
are very liquid and may contain gas. Haemor- enterotoxaemia in sheep is caused by C.
rhages or ulcers may be seen on the mucosal perfringens not C. spiriforme, which is the usual
surface of the caecum. The submucosa can be pathogen involved in enterotoxaemia. Exper-
thickened and oedematous. To be certain that imentally, the protective value of toxoids
enterotoxaemia was the cause of death, prepared from Clostridium spiriforme have
prompt post-mortem examination is required to been evaluated in laboratory and farm bred
differentiate the lesions from post-mortem rabbits (Ellis et al., 1991). The trials showed
changes. that a single vaccination at 4 weeks of age
Sometimes, enterotoxaemia can be was protective especially if a second dose was
confirmed by detection of the organism in administered 14 days later. Maternal
caecal contents. Comma shaped organisms immunity was not passed from vaccinated
may be seen on gram-stained caecal smears. dams to their offspring.
Anaerobic culture for 24–48 h on blood agar
is required to grow the organism. Anaerobic
conditions can be preserved by tying off a 10.10.3 Coliform enteritis
section of caecum or small intestine at each
end before it is removed and submitted to the Pathogenic strains of Escherichia coli can be a
laboratory. Alternatively a swab of intestinal major cause of enteritis and losses in colonies
contents can be immediately plunged to the of commercial rabbits or laboratories. E. coli is
286 Textbook of Rabbit Medicine

normally absent from the intestinal flora of suppression. Experimentally, corticosteroid

rabbits or is only present in small numbers. administration is required to reproduce the
Under some circumstances pathogenic strains disease (Delong and Manning, 1994). The
of the organism proliferate and cause organism penetrates the intestinal mucosa and
diarrhoea. Concurrent coccidiosis or dietary disseminates throughout the liver and eventu-
factors predispose to disease. Strains of E. coli ally the myocardium via the lymphatics.
vary in pathogenicity and some produce Tyzzer’s disease causes necrosis of the
endotoxins. Antibiotics can be effective in caecum, intestine, liver and heart. Peracute
treating some of the less virulent strains. cases may show intestinal lesions only.
There appears to be age susceptibility associ- Myocardial lesions occur later in the course of
ated with E. coil with suckling rabbits being the disease and lesions are principally found
most susceptible. At post-mortem examination, in the left ventricle and septum.
the small intestine may appear normal but Clinical signs include diarrhoea, faecal
there is inflammation of the caecum and large soiling of the perineum, dehydration and
intestine. In neonates, gram-stained smears death and are therefore non-specific.
from the small intestine may show large Weanling rabbits 6–12 weeks old are primar-
numbers of gram-negative rods (Okerman, ily affected, although the disease can affect
1988). In older animals, differential diagnosis rabbits of any age. In common with many of
from coccidiosis, enterotoxaemia, Tyzzer’s the infectious agents that cause diarrhoea in
disease and viral enteropathies depends on rabbits, Tyzzer’s disease is predisposed by
gross and microscopic changes and isolation stress, low fibre diets, intensive husbandry
of the pathogen. There may be concurrent and intercurrent disease.
disease such as rotavirus infection or Chronic infection can occur with intestinal
coccidiosis. Antibiotic therapy, poor stenosis and fibrosis occurring at the sites of
husbandry, overcrowding and stress are necrosis. There is little information about the
among predisposing factors. clinical syndromes associated with intestinal
stenosis or myocardial necrosis. Diagnosis is
usually made at post-mortem examination and
10.10.4 Tyzzer’s disease is confirmed by histological examination of
the liver where the organism can be seen in
Tyzzer’s disease is an inflammation of the hepatocytes. It is not known if Tyzzer’s
caecum caused by a sporulating, obligate disease is a significant cause of disease in
intracellular bacterium, which has recently adult pet rabbits in the UK. Serological and
been reclassified as Clostridium piliforme PCR tests may become available which would
rather than Bacillus piliformis based on molec- facilitate the screening of stock for carriers
ular studies of the genome (Besch-Williford, and aid diagnosis in the live animal.
1997). The disease usually occurs in weanling
rabbits 6–8 weeks old and is predisposed by
poor husbandry, overcrowding, immunosup- 10.10.5 Salmonellosis
pression and incorrect diet. Serological testing
of pet rabbits by the University of Missouri, In common with most animals, rabbits can
USA, reported an incidence of 47%, although suffer from salmonellosis although the
the majority of rabbits were asymptomatic disease is uncommon, especially in the
(Besch-Williford, 1997). individual pet. Salmonella typhimurium or S.
Spores from Clostridium piliforme are shed in enteriditis can cause diarrhoea, septicaemia
the faeces and can remain viable in the and rapid death.
environment for over a year. Oral ingestion of
spores from contaminated material results in
bacterial invasion of the epithelium of the 10.10.6 Viral causes of enteritis
lower small intestine and caecum. The
presence of antibodies in apparently healthy
animals suggests that the organism can reside
[Link] Rotavirus
latently in the gastrointestinal tract. Overt Rotavirus has been associated with outbreaks
disease is precipitated by stress or immuno- of enteritis, usually in rabbits under 6 weeks
 Digestive disorders 287

of age. In most cases, diarrhoea is mild although there are some anecdotal reports
(Thouless et al., 1996). Rotavirus was origi- and an abundance of myths (see Section
nally isolated from weanling rabbits with 2.17.2). Rabbits are known to be resistant to
diarrhoea, although it has also been recovered the toxic components of deadly nightshade
from unaffected animals (Bryden et al., 1976). and ragwort. However, it is wise to avoid
Serological tests have revealed that rotavirus exposure to plants that are known to be toxic
infection is widespread in colonies of domes- in other species (see Table 2.4).
tic rabbits. The disease has been reported in
many parts of the world including Japan,
Europe, Canada and the USA (DiGiacomo 10.11.2 Lead poisoning
and Mare, 1994). In infected colonies, adult
animals are seropositive and confer maternal Rabbits are susceptible to lead poisoning by
immunity on their offspring. The young chewing wood covered in lead-based paint,
rabbits become infected when maternal pipes or vinyl floor covering. The primary
immunity wears off which coincides with presenting signs are lethargy and reduced
weaning. Infected rabbits shed virus in faeces, appetite, which can progress to other
which is probably the main route of trans- symptoms (Swartout and Gerken, 1987).
mission, although there is evidence for Typical haematological changes of anaemia
airborne spread. Severity of clinical signs and basophilic stippling may be seen in
depends on virus strain, intercurrent disease, chronic cases. Reduced appetite appears to be
immune status and all the other factors that linked with slow gut motility. Radiographi-
are involved in enteric disease in weanling cally, radiopaque material may be seen in the
rabbits. In a study by Thouless et al. (1996), it stomach and unevacuated hard faeces may be
was found that concurrent infection with seen the large intestine. Treatment with motil-
rotavirus and E. coli resulted in increased ity agents such as cisapride or metaclo-
mortality and morbidity due to diarrhoeal pramide in addition to a chelating agent, such
disease compared with infection with E. coli as sodium calcium edetate or D-penicil-
alone. lamine, facilitates excretion of the lead from
the gut. An advantage of the rabbit’s rapid
elimination of large particles is that flakes of
[Link] Coronavirus lead paint will be quickly passed out in the
Rabbit enteric coronavirus (RECV) has been hard faeces rather than moved into the
reported in association with enteritis in caecum and retained in the body for longer
rabbits. The virus has also been associated periods before being re-ingested.
with pleural effusion and cardiomyopathy
and an analogy has been made with feline
infectious peritonitis (Deeb et al., 1993). RECV
has been implicated in outbreaks of enteric
10.12 Approach to an outbreak
disease in a barrier maintained rabbit colony of enteric disease in a breeding
(DiGiacomo and Mare, 1994). RECV is colony
unlikely to be a cause of disease in the pet
rabbit. Many rabbit breeders keep a small number of
animals that they use as exhibition animals
and sell young stock into the pet trade. In
10.11 Poisoning many cases, diseases are treated with home
remedies or by culling affected stock. Half-
truths, myths and legends abound, although
10.11.1 Plant toxicity some traditional remedies have a grain of
truth or some sound common sense in them.
Plant toxicity is a cause of concern to owners Professional veterinary advice is seldom
who give their rabbits the freedom of the sought except when a disease threatens all the
garden or pick plants to feed to their pets. stock, a prize-winning bloodline or perhaps a
Actual proven cases of plant toxicity in particularly valuable individual. Expense is
rabbits are rare in the veterinary literature always an issue. Cases of enteritis can be
288 Textbook of Rabbit Medicine

Key points 10.6

difficult and expensive to investigate and
• There are several Eimeria species that treat. Prompt, detailed post-mortem examina-
cause coccidiosis in rabbits. Mixed tions and laboratory investigations are
infections usually occur. There is no required. The causes are often multifactorial
cross-immunity between the species and home visits to examine the stock and
• Most Eimeria species affect the intes- assess the husbandry may be needed.
tine and heavy infestations cause
inappetance, weight loss and diarrhoea. Successful treatment of individual rabbits
Blood may be seen in the faeces with enteric conditions is difficult and usually
• One species, Eimeria steidae, has a expensive. Intensive therapy, including intra-
complex life cycle involving the bile venous fluids, hospitalization and nursing, is
ducts. Infection causes ‘hepatic required despite the breeder’s expectation
coccidiosis’, characterized by impaired that some ‘wonder drug’ will provide an
liver function. Heavy infestations result
in jaundice and liver failure instant cure. Therefore compromises have to
• Newly weaned rabbits are most suscep- be made and general principles applied to
tible to coccidiosis. It is rare in the prevent further losses. Post-mortem examina-
individual, adult pet tion is extremely valuable and all dead rabbits
• Sulpha drugs are used to treat coccidio- should be examined, not just one or two, as
sis in rabbits. The disease is controlled soon after death as possible. Microscopic
in commercial rabbit colonies and
breeding stock by including examination of impression smears, gut
coccidiostats in the food contents and faeces can be a cheap way of
• Enterotoxaemia is a cause of diarrhoea obtaining information. A provisional diagno-
and sudden death in rabbits. Clostridial sis of mucoid enteropathy, coccidiosis or
species, notably C. spiroforme, are the enterotoxaemia can be made from post-mortem
most usual pathogens examination, although concurrent infections
• Clostridia spp. can be present in the gut
flora of healthy rabbits. Disruption of can be present. Histology or specialized
the normal bacterial population allows laboratory techniques are required to confirm
clostridia to proliferate the diagnosis or detect viral infections.
• Stress, antibiotic therapy and dietary In general, it is often easier to prevent
change are predisposing factors to further losses than it is to treat existing
enterotoxaemia. Juvenile rabbits are outbreaks. It may be advisable for breeders to
most susceptible
• Glucose is required as a substrate for take a break in their breeding programme
enterotoxin formation by Clostridium and reduce stocking density so they have no
spiroforme. Juvenile rabbits absorb young susceptible rabbits on the premises for
carbohydrates less efficiently than a few weeks. A break gives the opportunity
adults. High carbohydrate diets are to clean and disinfect the premises
believed to be a predisposing cause of thoroughly, and reduce the number of
enterotoxaemia in growing rabbits in
commercial colonies pathogens in the environment. Simply
• Adult rabbits digest and absorb starch washing cages and hutches thoroughly in hot
efficiently from the small intestine and water and detergent to remove organic debris
high carbohydrate diets do not appear is beneficial and can be followed by the use
to predispose enterotoxaemia in adults of a disinfectant that kills viruses and bacte-
• The prognosis for rabbits with entero-
toxaemia is poor
ria. Povidone-iodine compounds such as
• Escherichia coli can cause diarrhoea. Tamodine (Vetark) or non-irritant Virkon can
Pathogenicity is affected by the strain of be used. Coccidial oocysts are particularly
E. coli and predisposing factors. resistant to disinfection but are susceptible to
Suckling rabbits are most susceptible desiccation. The use of a blowtorch to flame
• Other infectious causes of enteritis in hutches is a simple method of killing oocysts
rabbits include Tyzzer’s disease (caused
by Clostridium piliformis), salmonella
or a 10% solution of ammonia is effective
and viral infections such as rotavirus (Pakes and Gerrity, 1994). Ammonia is
• Poisoning can be manifested by diges- unpleasant and potentially hazardous to
tive disease. Heavy metal poisons such handle. Soil may need to be removed and
as lead or poisonous plants can be replaced in outdoor enclosures. The introduc-
ingested by rabbits, especially house tion of a feed containing a coccidiostat can be
rabbits.
required in the long term.
 Digestive disorders 289

References Deeb, B.J., DiGiacomo, R.F., Evermann, J.F., Thouless,

M.E. (1993). Prevalence of coronavirus antibodies in
rabbits. Lab Anim Sci., 43, 431–433.
Bentley, P.J. (1998). Comparative Vertebrate Endocrinology, Delong, D., Manning, P.J. (1994). Bacterial diseases. In
3rd edn. Cambridge University Press. The Biology of the Laboratory Rabbit, 2nd edn. (P.J.
Behara, N., Silveira, M., Man, W. et al. (1980). Manning, D.H. Ringler, C.E. Newcomer, eds).
Catecholamines and experimental stress ulcer: pp 131–170. Academic Press.
morphological and biochemical changes in the gastric DiGiacomo, R.F., Mare, J. (1994). Viral diseases. In The
mucosa (Abstract). Br J Surg., 67, 624–628. Biology of the Laboratory Rabbit, 2nd edn. (P.J. Manning,
Bergdall, V., Dysko, R.C. (1994). Metabolic, traumatic, D.H. Ringler, C.E. Newcomer, eds). pp 171–197.
mycotic and miscellaneous diseases. In The Biology of Academic Press.
the Laboratory Rabbit, 2nd edn. (P.J. Manning, D.H. Ellis, T.M., Gregory, A.R., Logue, G.D. (1991). Evaluation
Ringler, C.E. Newcomer, eds). pp 336–355. Academic of a toxoid for protection of rabbits against enterotox-
Press. aemia experimentally induced by trypsin-activated
Besch-Williford, C. (1997). Tyzzers disease in rabbits. In supernatant of Clostridium spririforme (Abstract). Vet
Rabbit Medicine and Procedures for Practitioners, Program Microbiol., 28, 93–102.
and Abstracts. House Rabbit Society Veterinary Confer- Fekete, S. (1989). Recent findings and future perspectives
ence, USA. of digestive physiology in rabbits: a review. Acta Vet
Blood, D.C., Studdert, V.P. (1999). Saunders Comprehensive Hung., 37, 265–279.
Veterinary Dictionary, 2nd edn. W.B. Saunders. Fekete, S., Bokori, J. (1986). The effect of trichobezoars on
Boucher S., Nouvelle L. (1997). Mucoid enteropathy the digestive coefficients and fattening indices of
syndrome (English Translation. Article in French) rabbits. J Appl Rabbit Res., 9, 54–55.
L'Eleveur de Lapins, No 67. Fioramonti, J., Ruckesbuch, Y. (1976). Caecal motility in
Breitweiser, B. (1997). Mucoid enteropathy in rabbits. the rabbit. III Duality of faecal excretion (English
Proc N Am Vet Conf., 11, 782–783. Abstract, article in French). Ann Rech Vet., 7, 281–
Bryden, A.S., Thouless, M.E., Flewett, T.H. (1976). 295.
Rotavirus and rabbits. Vet Rec., 99, 323. Fioramonti, J., Sorraing, J.M., Licois, D., Bueno, L. (1981).
Buckwell, A.C. (1987). Gut stasis in rabbits. Vet Rec., 120, Intestinal motor and transit disturbances associated
143. with experimental coccidiosis (Eimeria magna) in the
Carabaõ, R., Fraga, M.J., Santoma, G., de Blas, J. (1988). rabbit. Ann Rech Vét., 12, 413–420.
Effect of diet on composition of cecal contents and on Fraga, M.J., Perez de Ayala, P., Carabaõ, R., de Blas, J.C.
excretion and composition of soft and hard feces of (1991). Effect of type of fiber on the rate of passage and
rabbits. J Anim Sci., 66, 901–910. on the contribution of soft feces to nutrient intake of
Carabaõ, R., Piquer, J. (1998). The digestive system of the finishing rabbits (Abstract). J Anim Sci., 69, 1566–1574.
rabbit. In The Nutrition of the Rabbit (C. de Blas, J. Garcia, J., de Blas, J.C., Carabaõ, R., Garcia, P. (1995).
Wiseman, eds). pp 1–16. CABI Publishing. Effect of type of lucerne hay on caecal fermentation
Carman, R.J. (1993). Antibiotic associated diarrhea of and nitrogen contribution through caecotrophy in
rabbits. J Small Exotic Anim Med., 2, 69–71. rabbits (Abstract). Reprod Nutr Dev., 35, 267–275.
Carman, R.J. (1994). Clostridial enteropathies of rabbits. Gillett, N.A., Brooks, D.L., Tillman, P.C. (1983). Medical
J Small Exotic Anim Med., 2, 179–181. and surgical management of gastric obstruction from a
Carman, R.J., Evans, R.H. (1984). Experimental and hairball in the rabbit. J Am Vet Med Assoc., 183,
spontaneous clostridial enteropathies of laboratory and 1176–1178.
free living lagomorphs. Lab Anim Sci., 34, 443–450. Griffiths, I.R., Whitwell, K.E. (1993). Leporine dysau-
Charney, A.N., Arnold, M., Johnstone, N. (1983). Acute tonomia: further evidence that hares suffer from grass
respiratory alkalosis and acidosis and rabbit intestinal sickness. Vet Rec., 132, 376–377.
ion transport in vivo (Abstract). Am J Physiol., 244, Harcourt-Brown, F.M., Friggens, M.T. (1999). Intestinal
G145–150. obstruction in rabbits by locust bean seeds. Vet Rec.,
Cheeke, P.R. (1987). Rabbit Feeding and Nutrition. Acade- 145, 203.
mic Press. Harkness, J.E., Wagner, J.E. (1995). The Biology and
Cheeke, P.R., Grobner, M.A., Patton, N.M. (1986). Fiber Medicine of Rabbits and Rodents, 4th edn. Williams and
digestion and utilisation in rabbits. J Appl Rabbit Res., Wilkins.
9, 25–27. Harkness, J.E. (1997). Gastroenteric conditions in rabbits.
Chiou, P.W., Yu, B., Lin, C. (1998). The effect of different In Proceedings of the House Rabbit Society Veterinary
fibre components on growth rate, nutrient digestibility, Conference. pp 19–25.
rate of digesta passage and hindgut fermentation in Hinton, M. (1980). Gastric ulceration in the rabbit. J Comp
domestic rabbits. Lab Anim., 32, 276–283. Pathol., 90, 475–481.
De Blas, E., Gidenne, T. (1998). Digestion of starch and Hinton, M.H., Gibbs, C. (1982). Radiological examination
sugars. In The Nutrition of the Rabbit (C. de Blas, J. of the rabbit. II The abdomen. J Small Anim Pract., 23,
Wiseman, eds). pp 17–38. CABI Publishing. 687–696.
290 Textbook of Rabbit Medicine

Hotchkiss, C.E., Merritt, A.M. (1996a). Mucus secreta- Marty, J., Vernay, M. (1984). Absorption and metabolism
gogue activity in cecal contents of rabbits with mucoid of the volatile fatty acids in the hind-gut of the rabbit
enteropathy. Lab Anim Sci., 46, 179–186. (Abstract). Br J Nutr., 51, 265–277.
Hotchkiss, C.E., Merritt, A.M. (1996b). Evaluation of cecal McLaughlin, R.M., Fish, R.E. (1994). Clinical biochemistry
ligation as a model of mucoid enteropathy in specific and haematology. In The Biology of the Laboratory Rabbit,
pathogen-free rabbits (Abstract). Lab Anim Sci., 46, 2nd edn. (P.J. Manning, D.H. Ringler, C.E. Newcomer,
174–178. eds). pp 111–124. Academic Press.
Jackson, G. (1991). Intestinal stasis and rupture in rabbits. McLeod, C.G., Katz, W. (1986). Opportunist bacteria
Vet Rec., 129, 287–289. isolated from the caecum of rabbits with mucoid
Jean-Blain, C., Durix, A. (1985). Effects of dietary lipid enteritis. Br Vet J., 142, 177–187.
level on ketonaemia and other plasma parameters Milne, E. (1997). Grass sickness: an update. In Practice, 19,
related to glucose and fatty acid metabolism in the 128–133.
rabbit during fasting. Reprod Nutr Develop., 25, 345–354. Ojerio, A.D., Ladiges, W.C. (1981). Diagnostic exercise.
Jécsai, J., Teleki, M., Juhász, B. (1985). Effect of caecotro- Lab Anim Sci., 31, 33–34.
phy on protein and amino acid metabolism of Angora Okerman, L. (1988). Diseases of Domestic Rabbits. Black-
rabbits. Acta Vet Hung., 33, 51–57. well.
Jilge, B. (1980). The response of the caecotrophy rhythm Owen, D.G. (1992). Parasites of laboratory animals. In
of the rabbit to single light signals. Lab Anim., 14, 3–5. Laboratory Animal Handbooks No 12. Royal Society of
Joyner, L.P., Catchpole, J., Berret, S. (1983). Eimeria steidae Medicine Services Ltd.
in rabbits: the demonstration of different responses to Padilha, M.T., Licois, D., Gidenne, T. et al. (1995).
chemotherapy (Abstract). Res Vet Sci., 34, 64–67. Relationships between microflora and caecal fermenta-
Knudtzon, J. (1988). Plasma levels of glucagon, insulin, tion in rabbits before and after weaning (Abstract).
glucose and free fatty acids in rabbits during labora- Reprod Nutr Dev., 35, 375–386.
tory handling procedures. Z Versuchstierk, 26, 123–133. Pairet, M., Bouyssou, T., Ruckesbuch, Y. (1986). Colonic
Lafontan, M., Agid, R. (1979). An extra-adrenal action of formation of soft feces in rabbits: a role for endogenous
adrenocorticotrophin: physiological induction of lipol- prostaglandins. (Abstract). Am J Physiol., 250,
ysis by secretion of adrenocorticotrophin in obese G302–G308.
rabbits (Abstract). J Endocrin., 81, 281–290. Pakes, S.P., Gerrity, L.W. (1994). Protozoal diseases. In
Lafontan, M. (1981). Alpha-adrenergic responses in rabbit The Biology of the Laboratory Rabbit, 2nd edn. (P.J.
white fat cells: the influence of obesity and food restric- Manning, D.H. Ringler, C.E. Newcomer, eds).
tion (Abstract). J Lipid Res., 22, 1084–1093. pp 205–224. Academic Press.
Lang, J. (1981). The nutrition of the commercial rabbit. Patton, N.M., Holmes, P.R., Cheeke, P.R. (1983). Hairballs
Part 1. Physiology, digestibility and nutrient require- and pregnancy toxaemia. J Appl Rabbit Res., 6,
ments. Nutr Abstracts Rev-Series B, 51, 197–217. 98–99.
Leary, S.L., Manning, P.J., Anderson, L.C. (1984). Exper- Peeters, J.E., Geeroms, R. (1986). Efficacy of toltrazuril
imental and naturally occurring foreign bodies in against intestinal and heptic coccidiosis in rabbits
laboratory rabbits. Lab Anim Sci., 34, 58–61. (Abstract). Vet Parasitol., 1, 21–35.
Lelkes, L., Chang, C.L. (1987). Microbial dysbiosis in Pere, M.C., Baudelin, A., Briggs, K., Gilbert, M. (1992).
rabbit mucoid enteropathy. Lab Anim Sci., 36, 757–764. Hepatic metabolism during fasting-refeeding transition
Licois, D., Mongin, P. (1980). An hypothesis of the patho- in conscious pregnant rabbits (Abstract). Am J Physiol.,
genesis of diarrhoea in the rabbit based on intestinal 262, E899–E905.
contents (Article in French, English Abstract). Reprod Perkins, S.E., Fox, J.G., Taylor, N.S. et al. (1995). Detection
Nutr Dev., 20, 1209–1216. of clostridium difficile toxins from the small intestine
Licois, D., Coudert, P., Mongin, P. (1978). Changes in and cecum of rabbits with naturally acquired entero-
hydromineral metabolism in diarrhoeic rabbits 2. toxaemia. Lab Anim Sci., 45, 379–447.
Study of the modifications of electrolyte metabolism. Redfern, J.S., Lin, H.J., McArthur, K.E. et al. (1991).
Ann Rech Vet., 9, 453–464. Gastric acid and pepsin secretion in conscious rabbits.
Licois, D., Guillot, J.F., Mouline, C., Reynaud, A. (1992). Am J Physiol., 261, G295–G304.
Susceptibility of the rabbit to an enteropathogenic Riley, J.H., Cornelius, L.M. (1989). Electrolytes, blood
strain of Escherichia coli 0103; effect of animals age gases, and acid base balance. In The Clinical Chemistry
(Abstract). Ann Rech Vet., 23, 225–232. of Laboratory Animals (W.F. Loeb, F.W. Quimby, eds).
Lofqvist, J. Nilsson, E. (1981). Influence of acid-base pp 345–407. Pergamon Press.
changes on carbechol and potassium induced contrac- Sandford, J.C. (1996). The Domestic Rabbit, 5th edn. Black-
tions of taenia coli of the rabbit (Abstract). Acta Physiol well Science.
Scand., 111, 59–68. Schmidt, R.E. (1995). Protozoal diseases of rabbits and
Madry, K., Lut, W., Lepert, R. et al. (1976). Lipid compo- rodents. Sem Avian Exotic Pet Med., 4, 126–130.
sition of plasma obtained from various parts of the Straw, T.E. (1988). Bacteria of the rabbit gut and their role
vascular system of the rabbit. Acta Physiol Pol., 27, in the health of the rabbit. J Appl Rabbit Res., 11,
485–492. 142–146.
 Digestive disorders 291

Swartout, M.S., Gerken, D.F. (1987). Lead induced toxico- Van der Hage, M.H., Dorrestein, G.M. (1996). Caecal
sis in two domestic rabbits. J Am Vet Med Assoc., 191, impaction in the rabbit: relationships with dysautono-
717–719. mia. Proc 6th World Rabbit Congr., 3, 77–80.
Talbot, A.C., Ireton, V.J. (1975). Unusual cause of intesti- Verde, M.T., Piquer, J.G. (1986). Effect of stress on the
nal blockage in the female rabbit. Vet Rec., 96, 477. cortisone and ascorbic acid content of the blood plasma
Thouless, M.E., DiGiacomo, R.F., Deeb, B. (1996). The of rabbits. J Appl Rabbit Res., 9, 181–182.
effect of combined rotavirus and Escherichia coli infec- Vernay, M. (1987). Origin and utilisation of volatile fatty
tions in rabbits. Lab Anim Sci., 46, 381–384. acids and lactate in the rabbit: influence of the faecal
Toofanian, F., Targowski, S. (1983). Experimental produc- excretion pattern. Br J Nutr., 57, 371–381.
tion of rabbit mucoid enteritis. Am J Vet Res., 44, Whitwell, K.E. (1991). Do hares suffer from grass
705–708. sickness? Vet Rec. 128, 395–396.
Toofanian, F., Hamar, D.W. (1986). Cecal short-chain Whitwell, K., Needham, J. (1996). Mucoid enteropathy in
fatty acids in experimental rabbit mucoid enteropathy UK rabbits: dysautonomia confirmed. Vet Rec., 139,
(Abstract). Am J Vet Res., 47, 2423–2425. 323–324.

View publication stats