Downloaded from inpractice.bmj.com on June 29, 2012 - Published by group.bmj.
com
Companion animal practice
Brigitte Lord graduated from
the Royal Veterinary College in
2002. After a period in exotic and
small animal practice, she spent
time at the Royal (Dick) School of
Veterinary Studies in Edinburgh
and the University of Bristol/
Bristol Zoo, and ran a rabbit and
exotics veterinary referral service in
south-west England. She returned
to Edinburgh in 2008 as a lecturer
in rabbit medicine and surgery,
and is now head of the universitys
exotic animal handling facility.
She is also the veterinary adviser
for the British Rabbit Council.
She holds the RCVS certificate
in zoological medicine and is
currently working towards the
diploma in zoological medicine.
doi:10.1136/inp.e973
Provenance: Commissioned
and peer-reviewed
Fig 1: Normal gastrointestinal
tract of a rabbit on postmortem
examination. The large caecum
(F) is typical of a hindgut
fermenter species. A Stomach,
B duodenum, C pancreas,
D jejunum, E sacculus rotundus,
F caecum, G caecal appendix,
H proximal colon, I fusus coli,
J distal colon, K rectum, L anus
156 In Practice March 2012 | Volume 34 | 156162
Gastrointestinal disease in rabbits
2. Intestinal diseases
Brigitte Lord
Intestinal diseases in rabbits can develop as a result of many causes. Diet-
related problems are a common aetiology of intestinal disorders but infectious
(bacterial, viral, parasitic), idiopathic and neoplastic diseases are also seen
with relative frequency. This article describes the diagnosis and approach to
treatment of intestinal diseases in rabbits. An article in the February issue of
In Practice (volume 34, pages 90-96) considered gastric diseases in this species.
Intestinal ileus and obstruction Diagnosis
The history and clinical findings of a firm, dough-like
Caecal stasis is primarily an acquired disorder of or gas-filled caecum on palpation allow a presumptive
decreased motility. Generalised ileus is a common con- diagnosis of caecal stasis and ileus. Non-obstructive
tinuation of this condition and may arise from mechan- and obstructive ileus can usually be differentiated
ical obstruction or from defective propulsion, as seen on the basis of the clinical appearance of the rabbit
with gastric stasis (see Part 1). Obstruction of the small and its response to treatment, although advanced
and the large intestine has been reported in rabbits, non-obstructive disease may be more challenging to
with the small intestine being more commonly affected interpret (see Box 1). Non-obstructive ileus can usu-
(Harcourt-Brown 2007). Foreign bodies were most fre- ally be managed medically, while obstructive ileus will
quently found in the small intestine and included locust require surgical treatment.
bean seeds from mixed muesli-type rations, carpet fibre Radiography is indicated if obstructive disease
and pellets of compressed hair. Post-surgical adhe- is suspected. Dilation of the region proximal to the
sions, an inguinal hernia and a tapeworm cyst causing obstruction is diagnostic for the condition and, in such
strangulating obstructions of both the small and large cases, an emergency laparotomy should be carried out,
intestines were seen. Neoplasia was found to cause
obstruction in all areas of the gastrointestinal tract.
Rabbits have complex large intestines, which are
typical of hindgut fermenter species (Fig 1), in contrast
to the simple gastrointestinal tract of cats or dogs.
A
C
H
E
F
G
I
Fig 2: Dorsoventral abdominal radiograph of a rabbit
showing gas distension of the caecum, which has been
K L displaced to the left side of the abdomen
 Downloaded from inpractice.bmj.com on June 29, 2012 - Published by group.bmj.com
Box 1: Diagnosis and management of ileus
Non-obstructive
ileus
History
Gradual onset over a period of days
Decreased appetite or anorexia
Decreased or absent faecal pellets
Rabbit is bright, alert and responsive
Physical examination
Pink, moist or tacky mucous membranes
Capillary refill time <2 seconds
Dough-like caecum and/or stomach on gentle abdominal
palpation
Gas may be obvious on palpation of the gastrointestinal tract
Rectal temperature 38 to 385C (within normal limits)
Animal is bright, alert and responsive
Medical treatment
Buprenorphine (003 to 005 mg/kg every 6 to 8 hours,
orally, intravenously, subcutaneously or intramuscularly)
Meloxicam (03 to 06 mg/kg every 24 hours, orally
or subcutaneously)
Ranitidine (4 to 6 mg/kg every 8 to 12 hours, orally
or subcutaneously)
Intravenous fluid therapy with Hartmanns solution at
twice the maintenance rate (8 ml/kg/hour)
High-fibre recovery diet (eg, Critical Care; Oxbow),
10 ml/kg per feed, every 4 hours
Fig 3: Lateral abdominal radiograph of the same rabbit
as pictured in Fig 2, showing the gas-filled caecum.
The stomach is full of ingesta, and the small intestine
and colon are empty
as described below. Serial radiographs may be useful
in some cases to confirm a suspicion of obstruction.
In advanced cases of ileus, the stomach often contains
ingesta but the large and small intestines are gas-filled
(Figs 2, 3).
Treatment and prognosis
Aggressive medical management is required to prevent
further deterioration and death in rabbits with intes-
tinal stasis and ileus. The provision of rehydration,
analgesia, prokinetics and nutritional support with a
high-fibre diet is vital in these cases, as described in
Part 1 for gastric stasis and ileus.
Companion animal practice
Ileus
Obstructive
ileus
History
Rapid onset, within 24 hours
Anorexia
Absent faecal pellets
Rabbit may be quiet, alert and reactive, depressed,
non-responsive or collapsed
Physical examination
Pale pink or grey, tacky mucous membranes
Capillary refill time >2 seconds
Dough-like caecum and/or stomach on gentle abdominal
palpation
Gas may be obvious on palpation of the gastrointestinal tract
Rectal temperature 38 to 385C or hypothermic
Animal is quiet, alert and reactive, depressed or collapsed
Diagnostic investigation
Conscious lateral and dorsoventral abdominal radiography
Blood sampling for measurement of packed cell volume,
total protein, albumin, alanine aminotransferase, alkaline
phosphatase, creatinine and urea
Management
Exploratory laparoscopy or laparotomy is indicated if obstruction
is suspected on radiography
Otherwise, treat medically as for non-obstructive ileus
If obstructive disease is suspected or diagnosed on
radiography, an exploratory laparotomy is indicated.
These patients are likely to be critically ill, so care must
be taken in the perioperative period. The anaesthesia
protocol described in Part 1 for gastrotomy procedures
is recommended. A routine laparotomy incision should
be made as described for a gastrotomy (see Part 1) and
the entire gastrointestinal tract should be explored. The
area of affected bowel should be exteriorised (Fig 4)
and the abdomen packed off adequately to prevent
contamination. An assistants fingers or atraumatic
Fig 4: Exploratory laparotomy can be made a lot easier
by using a retractor. The large caecum is present just
below the abdominal muscle layer, so care must be
taken on entering the abdomen to make sure the
caecum is not lacerated
In Practice March 2012 | Volume 34 | 156162 157
 Downloaded from inpractice.bmj.com on June 29, 2012 - Published by group.bmj.com
Companion animal practice

forceps should be used to prevent ingesta contamin
ating the surgical field. Ideally, an incision should be
made in a healthy portion of intestine, and the foreign
body can then be milked into the incision. Milking
a small intestinal foreign body into the caecum for
removal, where possible, may reduce the likelihood of
mortality. For firmly attached obstructions, an inci-
sion should be made just next to the lesion. If the cause
of obstruction is a foreign body, it should be removed
or, in the case of a neoplasm, an enterectomy and histo
pathology of the excised tissue should be considered.
If no intestine is removed, the incision can be closed
with a simple interrupted suture pattern using syn-
thetic absorbable monofilament material (eg, poly
dioxanone [PDS II; Ethicon]). If the incision was made
in the caecum, a second layer of inverting sutures
should be placed. It is important to use a small needle
to prevent leakage of the caecal contents or tearing
through this very thin-walled structure. Omentum
can be tacked around the incision site. The abdomen is
then closed as described for gastrotomy (see Part 1).
Perioperative mortality can be high in rabbits with
intestinal obstructions, but with excellent periopera-
tive care a good outcome can be achieved. The progno-
sis is grave for rabbits with an obstructing neoplasm,
and euthanasia should be considered in such cases.
Parasitic enteritis
Nematodes and cestodes
Passalurus ambiguus, the pinworm, is common in
domestic rabbits and widespread in wild rabbits.
Embryonated P ambiguus ova are transmitted by the
faeco-oral route. Adult worms, which are 2 to 11 mm
long, inhabit the caecum and colon, and are often
seen when they are passed in fresh faeces. Graphid
ium stringosum, Trichostrongylus retortaeformis and
Trichostrongylus calcaratus are nematodes found com-
monly in wild rabbits in Europe, and domestic rabbits
allowed to graze infected pasture may acquire these
infections (Allan and others 1999).
Rabbits are the intermediate host for several tape-
worms that affect dogs and foxes, including:
The larval stage of Taenia pisiformis (sometimes
known as Cysticercus pisiformis);
The larval stage of Taenia serialis (sometimes called
Coenurus serialis);
Echinococcus granulosus.
Transmission of these species is by the ingestion of
eggs shed in the faeces of carnivore hosts. The larvae
migrate from the intestines to their predilection sites:
the liver, lung, lymph nodes, intermuscular connective
tissue and, occasionally, the orbit or brain.
Rabbits are one of the primary hosts for Cittotaenia
variabilis. Oribatid mites may be the intermediate host
of this species.
Generally, P ambiguus is considered to be non-
pathogenic, although rabbits with heavy infections
may show perianal pruritus. Cestode infections are
usually asymptomatic, but abdominal distension,
lethargy and weight loss may be seen in cases of heavy
infection. Tserialis usually forms subcutaneous cysts,
which can be palpated as soft tissue swellings (Bethell
and Truszkowska 2010). The clinical signs will depend
on the site and extent of the space-occupying lesion.

Table 1: Drugs used in the treatment of intestinal disease in rabbits

Dose and route of administration Comments
Antibiotics
Enrofloxacin 20 mg/kg every 24 hours, po or sc Administration via the sc route can cause
tissue damage. Licensed for rabbits
Marbofloxacin 4 mg/kg every 24 hours, po, sc or iv
Metronidazole 20 mg/kg every 12 hours, po
Trimethoprim-sulfadiazine 30 mg/kg every 12 hours, sc Can also be used to treat coccidiosis
Trimethoprim-sulfamethoxazole* 30 mg/kg every 12 hours, po Can also be used to treat coccidiosis
(10-day course)
Antiparasitics
Amprolium 20 mg/kg every 24 hours, po Used to treat coccidiosis (5-day course)
Fenbendazole 10 to 20 mg/kg every 24 hours, po Used to treat Passalurus ambiguus, for which
the dose should be repeated after 14 days
Ivermectin 02 to 04 mg/kg, po or sc Not effective for P ambiguus. A single dose
can be used for other roundworms
Piperazine 200 mg/kg, po Repeat after 2 to 3 weeks
Praziquantel 5 to 10 mg/kg, po, sc or im Used to treat cestode infections, for which
the dose should be repeated after 10 days
Selamectin 6 mg/kg, topically Used to treat roundworm infections
Sulfadimethoxine 50 mg/kg once, po, then 25 mg/kg Used to treat coccidiosis (10- to 20-day
every 24 hours, po course)
Miscellaneous
Cholestyramine* 500 mg/kg every 12 hours, po Used to treat enterotoxaemia. Binds to
bacterial toxins
Loperamide hydrochloride* 01 mg/kg every 8 hours for 3 days, Can be useful in cases of dysbiosis
then every 24 hours for 2 days, po
im Intramuscularly, iv Intravenously, po orally, sc subcutaneously
*Not licensed for use in animals, so the prescribing cascade must be followed
For details of prokinetics, analgesics and fluid therapy, see Table 2 in Part 1

158 In Practice March 2012 | Volume 34 | 156162

 Downloaded from inpractice.bmj.com on June 29, 2012 - Published by group.bmj.com
Diagnosis
P ambiguus ova can be observed on faecal flotation
or by examination of fresh faecal smears. A definitive
diagnosis of tapeworm infection can be made on exam-
ination of a tissue biopsy or fluid aspirated from cysts.
Treatment and prognosis
Anthelmintics that can be used to treat nematode
or cestode infections in rabbits are listed in Table 1.
T serialis cysts should ideally be surgically excised
or drained by aspiration. The prognosis for recovery
is good, unless the animal is severely affected by the
space-occupying lesion or shows severe liver pathol-
ogy. Prevention of worm infections in rabbits can be
achieved by ensuring that they do not have access to
grass contaminated with carnivore faeces.
Cryptosporidiosis
Rabbits become infected with Cryptosporidium parvum
when they ingest sporulated oocysts. These are shed in
wild or domestic rabbit or rodent faeces, but may also
be transmitted in water, fomites or contaminated feed.
The prepatent period is three to 21 days. Adult rabbits
tend to be subclinically infected and show no clinical
signs unless they are immunocompromised. Infected
neonatal or young rabbits may show lethargy, poor
body condition, poor coat quality, decreased appetite,
dehydration, weight loss and pasty, unformed faeces or
diarrhoea lasting for three to five days.
Diagnosis
The diagnosis of cryptosporidiosis requires finding
the oocysts on faecal examination (see Part 1).
Treatment and prognosis
Currently, there are no treatments known to be reli-
able for cryptosporidiosis in rabbits. The prognosis for
recovery is guarded to good, depending on the sever-
ity of infection and the degree of villous blunting in
the intestine. Young rabbits with severe stunting may
never attain their anticipated body size.
Intestinal coccidiosis
Many different species of Eimeria have been identi-
fied in rabbits. Eimeria perforans, Eimeria media
and Eimeria magna are widespread in breeding col-
onies of domestic rabbits, while E perforans is the
most common species in wild rabbits. Transmission
is via ingestion of sporulated oocysts. The prepatent
period for Eimeria species ranges from two to 10 days,
and, at a temperature of 20C, sporulation requires
22 hours for E perforans and 70 hours for Eimeria
piriformis.
Intestinal coccidiosis is most often a subclinical
disease in immunocompetent adult rabbits. The fac-
tors predisposing to clinical disease are:
Coinfection with other enteropathogens;
Immunosuppression or a naive immune system;
The dose of infection present;
The species of Eimeria involved. E perforans affects
the small intestine and, although it is associated
with only slight pathogenicity, is the predominant
species. E magna and Eimeria irresidua are the
most pathogenic intestinal Eimeria species found
in rabbits, and also affect the small intestine.
Companion animal practice
A
Fig 5: (a) Perineal faecal
staining in a rabbit with
acute-onset diarrhoea.
(b) Postmortem examination
of the rabbit revealed a fluid-
and gas-filled colon. Large
numbers of coccidial oocysts
B were found on cytology
The clinical signs include weight loss, mild to
severe intermittent or continuous haemorrhagic diar-
rhoea, dehydration and, occasionally, intestinal intus-
susception. Death is usually associated with secondary
bacterial enteritis and dehydration (Fig 5).
Diagnosis
Coccidiosis is presumptively diagnosed by finding
oocysts on faecal flotation. Even repeated faecal exam-
ination may reveal only small numbers of oocysts, but
it is important to remember that the amount of oocysts
does not correlate directly with their clinical signifi-
cance (ie, the presence of even a few oocysts can cause
significant clinical disease). A definitive diagnosis
requires histopathological examination of the ileum
and/or jejunum, where coccidia may be identified
within parasitised epithelial cells. These cells often
die, which may lead to ulceration and a mixed poly-
morphonuclear and mononuclear exudate.
Treatment and prognosis
Treatments for coccidiosis are listed in Table 1. In mild
cases, the prognosis is good and the rabbit may develop
lifelong immunity.
Bacterial enteritis
Clostridiosis and dysbiosis
The bacteria Clostridium spiroforme, Clostridium dif
ficile and Clostridium perfringens are associated with
enteritis and enterotoxaemia in rabbits. Tyzzers dis-
ease is caused by Clostridium piliforme. Clostridium
species are widespread pathogenic bacteria but also
inhabit the gastrointestinal tract of adult rabbits as part
of the normal intestinal flora, along with Bacteroides,
Enterococcus, Staphylococcus and Enterobacter spe-
cies and Escherichia coli.
In Practice March 2012 | Volume 34 | 156162 159
 Downloaded from inpractice.bmj.com on June 29, 2012 - Published by group.bmj.com
Companion animal practice
Disease in adult rabbits may develop as a result of
dysbiosis. The predisposing factors involved in caecal
dysbiosis include:
A sudden change in diet altering the caecal pH and
motility;
Stress, causing immunosuppression and decreased
gastrointestinal tract motility;
Administration of antibiotics, causing suppression of
Box 2: PLACE the normal microbial flora. The PLACE mnemonic
mnemonic for (see Box 2) can be used to remember which antibiot-
antibiotics to ics to avoid in rabbits, as they can be associated with
avoid in rabbits fatal enterotoxaemia, especially if given orally.
Bacteria such as Bacteroides species normally exert
P: Penicillins
L: Lincosamides an inhibitory effect on potentially pathogenic bacteria
A: Aminoglycosides including Clostridium species and coliforms.
C: Cephalosporins Disease in neonatal rabbits and weanlings may be
E: Erythromycin associated with a high gastric pH of 5 to 65, which
allows clostridial proliferation and an underdeveloped
population of normal gastrointestinal microbial flora.
In young rabbits aged one to two months, diversifica-
tion of the antibody repertoire has been shown to rely
on interactions between the gut-associated lymphoid
tissue and specific members of the normal gastrointes-
tinal microflora. Tyzzers disease has been associated
with the stress of overcrowding, unsanitary conditions
and concurrent disease.
Rabbits with dysbiosis may show:
Anorexia;
Depression;
Dehydration;
Hypothermia;
Intermittent or continuous diarrhoea with haemato
chezia and mucus.
In acute cases, enterotoxic shock and death can
occur within 24 to 48 hours. Chronic cases are occa-
sionally seen, and are characterised by intermittent
diarrhoea and weight loss.
Diagnosis
A presumptive diagnosis of dysbiosis can be made
based on a history of recent antibiotic administration,
a change of diet or stress.
Treatment and prognosis
Aggressive fluid and supportive therapy are essential in
rabbits with dysbiosis, which are likely to be in a criti-
cal condition. Cholestyramine has been shown to bind
to bacterial toxins, including clostridial cytotoxin and
endotoxin, in humans. Loperamide hydrochloride and
a high-fibre diet can improve the recovery.
The role of probiotics in these cases is still
being studied, but transfaunation by administering
fresh caecot rophs from
healthy rabbits can
Box 3: Transfaunation provide the appropriate
microflora to help re-
Place an Elizabethan collar on a donor rabbit overnight establish caecal homeo
to prevent coprophagy
stasis (see Box 3). The
Collect the caecotrophs produced by the donor and
place them directly into the diastema of the mouth of prognosis for recovery
the sick rabbit of mild cases, which
If the rabbit refuses them, mix the fresh caecotrophs can be treated with
with a small amount of water and administer the dietary adjustments,
suspension orally by syringe can be good, but severe
Administer a small number of caecotrophs (five to 10)
cases have a poor
every three hours
prognosis.
160 In Practice March 2012 | Volume 34 | 156162
Colibacillosis
The presentation of colibacillosis in rabbits is variable
and depends on the particular strain of E coli, as well
as on the presence of concurrent infectious agents.
The rabbit enteropathogenic E coli (rabbit EPEC or
RDEC-1) strain is the most common cause of bacterial
enteritis in this species. Transmission is by the faeco-
oral route. Neonatal rabbits aged one to 14 days, or
young animals between two and four months, that are
stressed by weaning, transport or overcrowding, are
most likely to be clinically affected. The clinical signs
include acute weight loss and diarrhoea, intussuscep-
tion and rectal prolapse. Mortality ranges between 50
and 100 per cent.
Salmonella species, Pseudomonas aeruginosa,
Yersinia pseudotuberculosis and Lawsonia intra
cellularis can also cause acute or chronic entero-
colitis in rabbits. Neonates and weanlings are most
severely affected, and the morbidity and mortal-
ity can vary. Transmission is by the faeco-oral route
or via contaminated feed or water. It is impor-
tant to be aware that such infections have zoonotic
potential.
Diagnosis
Colibacillosis can be diagnosed presumptively by iso-
lating E coli in the faeces of affected animals, although
dysbiosis often causes the proliferation of non-
pathogenic E coli. A definitive diagnosis is based on
histopathological identification of E coli attachment
to enterocytes.
In cases where Salmonella species, P aeruginosa,
Ypseudotuberculosis or L intracellularis are suspected,
the diagnostic laboratory must be informed, as spe-
cific enrichment and selection procedures are recom
mended for faecal bacterial culture and sensitivity
testing of these organisms.
Treatment and prognosis
Affected animals should be treated with broad-
spectrum antibiotics while the results of bacterial
culture and sensitivity testing are pending. Early,
aggressive fluid and supportive therapy, including the
administration of loperamide hydrochloride, is essen-
tial to increase the chances of a successful outcome.
The prognosis is guarded to poor but will depend on
the strain of bacteria involved, the immunocompe-
tence of the patient and the presence of synergistic
copathogens, such as rotavirus.
Viral enteritis
Viral enteritis is primarily seen in young weanling
rabbits. Coronavirus has been reported to affect ani-
mals 21 to 70 days of age, and rotavirus is most com-
mon in rabbits aged 30 to 80 days. These pathogens
are transmitted by the airborne and faeco-oral routes.
Viral infection causes villous atrophy with lympho
cytic inflammation, particularly in the ileum, and
intestinal distension.
Maternal antibody to rotavirus can provide some
protection in young rabbits, resulting in subclini-
cal shedding of virus for about three days. Soft to
diarrhoeic faeces are often the main clinical sign
 Downloaded from inpractice.bmj.com on June 29, 2012 - Published by group.bmj.com
of rotavirus infection. Coinfection with rotavirus
and E coli has been shown to result in an increased
mortality of 50 to 80 per cent due to diarrhoeal disease
(Thouless and others 1996). Coronavirus infections
are associated with high morbidity and mortality.
Diagnosis
Rotavirus infection can be diagnosed on virus isola-
tion, the detection of specific antibodies or histo
pathology. A definitive diagnosis of coronavirus can
be made on histopathology or isolation of virus in the
faeces. However, both rotavirus and coronavirus can
be found in clinically normal adult rabbits.
Treatment and prognosis
Supportive treatment of rotavirus infection is usually
successful, except in cases of simultaneous coinfection
with another enteropathogen, which carries a guarded
prognosis. Coronavirus enteritis has a guarded to
poor prognosis.
Mucoid enteropathy
Mucoid enteropathy (also called rabbit epizootic
enteropathy) is an idiopathic condition that results
in goblet cell hyperplasia and excessive mucus pro-
duction within the intestinal tract. The condition is
mainly seen in young rabbits aged from four to 14
weeks, although there have been reports of cases in
older animals. It may occur concurrently with other
enteropathies. Lesions of mucoid enteropathy have
been found in association with caecal hyperacid-
ity due to abnormal volatile fatty-acid production
or absorption, dysbiosis, a fibre-deficient diet and
dysautonomia.
The clinical signs that have been reported in cases
of mucoid enteropathy include:
Anorexia;
Depression;
Abdominal pain and distension;
Weight loss;
Dehydration;
Hypothermia;
Diarrhoea initially, progressing to mucus excre-
tion; or
Constipation and palpation of a firm, dough-like,
large caecum.
Acute mortality can occur within one to three days,
reaching rates of 30 to 80 per cent. In chronic disease,
mortality may occur within seven to nine days.
Diagnosis
A presumptive diagnosis of mucoid enteropathy can
be made on the history and clinical signs, although the
condition can mimic other enteropathies. Radiography
may reveal evidence of caecal impaction and, in more
advanced cases, evidence of gastric and intestinal
stasis. A definitive diagnosis is made on postmortem
findings of copious intestinal mucus and goblet cell
hyperplasia.
Treatment and prognosis
Non-specific supportive treatment is recommended
for affected animals, but the prognosis is poor. Feeding
Companion animal practice
a high-fibre and low-carbohydrate diet can help to
prevent mucoid enteropathy from developing.
Dysautonomia and caecal impaction
Dysautonomia in rabbits is an idiopathic condition
that causes a loss of function of the autonomic nerv-
ous system. The condition is associated with signs of
gastrointestinal stasis and autonomic nerve deficits.
Clinical signs include:
Dry mucous membranes and conjunctiva;
Dilated pupils;
Bradycardia;
Urine retention and overflow incontinence;
A dilated, firm, impacted colon;
Proprioceptive deficits;
Loss of anal tone.
Accumulation of food in the mouth, dysphagia and
evidence of lower respiratory disease due to aspira-
tion pneumonia, secondary to dysphagia and mega
oesophagus, may also be seen. As in other species, such
as hares and horses, dysautonomia in rabbits is associ-
ated with high mortality.
Diagnosis
Dysautonomia can be diagnosed presumptively based
on the clinical signs. Radiography of the thorax and
abdomen may reveal evidence of aspiration pneu-
monia, megaoesophagus, an impacted colon and
a large bladder. The absence of tear production can
be demonstrated using a Schirmer tear test; the aver-
age tear production in healthy rabbits is 5 24 mm/
minute (Abrams and others 1990). A definitive diag-
nosis requires postmortem histology and electron
microscopy.
Treatment and prognosis
Rabbits with dysautonomia should receive support-
ive treatment, including fluid therapy, force-feeding,
lubricating the eyes, the use of enemas and emptying
the bladder. The prognosis in rabbits is poor, although
some animals of other species have spontaneously
recovered.
Intestinal neoplasia
Anorectal papillomas are well-differentiated benign
tumours and are not related to viral papillomas of
the skin and oral cavity. They are small, friable,
fungating masses that originate from the rectal
squamous columnar epithelium at the anorectal
junction. The clinical signs include constipation, dis-
comfort, haemorrhage from the anus and, in severe
cases, rectal prolapse; some affected rabbits may be
asymptomatic.
Neoplastic infiltrations, including lymphomas,
adenocarcinomas, leiomyosarcomas and metastatic
haemangiosarcomas, have been reported as spontane-
ous neoplasms of the intestinal tract in several breeds
of rabbit. Metastasis of uterine adenocarcinomas across
the peritoneal cavity has also been reported. Some
rabbits may show no clinical signs until the disease
is advanced and sudden death occurs. Clinical signs
In Practice March 2012 | Volume 34 | 156162 161
 Downloaded from inpractice.bmj.com on June 29, 2012 - Published by group.bmj.com
Companion animal practice
that may be seen in animals with intestinal tumours
include:
Diarrhoea;
Gastrointestinal ileus or obstruction;
Anorexia;
Ascites;
Emaciation;
Depression;
Pallor;
Cutaneous nodules (in cases of lymphoma);
Peripheral lymphadenopathy.
Enlarged abdominal lymph nodes causing com-
pression of the intestines may also be seen in rabbits
with lymphomas.
Diagnosis and treatment
Anorectal papillomas are usually presumptively diag-
nosed based on the clinical features, but excisional
biopsy and histopathology are required for a definitive
diagnosis. Surgical excision of anorectal papillomas is
curative, provided all of the abnormal tissue is removed.
In asymptomatic cases, spontaneous regression can
occur. The prognosis for a full recovery is good.
Infiltrative neoplasias may require more exten-
sive diagnostic investigation. Lymphocytosis may be
seen on routine haematology and, in such cases, lym-
phoma should be suspected. Thoracic and abdominal
radiographs may reveal a primary tumour or metasta-
sis. Barium enemas may aid the diagnosis of a space-
occupying lesion in the colon. Ultrasonography can be
used to demonstrate the normal layering and thick-
ness of the intestines, provided there is not too much
gas in the intestines causing shadowing. Prominent
mesenteric lymph nodes and regional abnormalities,
and small peritoneal effusions, suggesting infiltrative
disease, may also be found on ultrasonography. Biopsy
and histopathology is required for a definitive diag-
nosis. Biopsies may be obtained endoscopically from
the distal colon. Laparotomy or laparoscopy will be
required to obtain biopsies from the small intestine,
caecum or proximal colon (Fig 6).
Cases of infiltrative neoplasia could be treated by
chemotherapy, extrapolating the protocols used in
cats and dogs. As with gastric neoplasias (see Part 1),
the prognosis will depend on the stage of the disease
when it is diagnosed and the response to treatment.
D in the intestines of rabbits.
P
C
Fig 6: Image of the abdomen of a rabbit taken using
a laparoscopic camera, showing the duodenum (D),
pancreas (P) and caecum (C)
162 In Practice March 2012 | Volume 34 | 156162
Summary
Appropriate investigation of the clinical signs of intes-
tinal disease in rabbits, and specific treatment of the
underlying cause, is vital to achieving an optimum out-
come in these animals, which, as with all prey species,
will actively hide signs of disease.
References
ABRAMS, K. L., BROOKS, D. E., FUNK, R. S. & THERAN, P.
(1990) Evaluation of the Schirmer tear test in clinically normal
rabbits. American Journal of Veterinary Research 51,
1912-1913
ALLAN, J. C., CRAIG, P. S., SHERINGTON, J., ROGAN,
M.T., STOREY, D. M., HEATH, S. & IBALL, K. (1999)
Helminth parasites of the wild rabbit Orycytolagus cuniculus
near Malham Tarn, Yorkshire, UK. Journal of Helminthology
73, 289-294
BETHELL, F. & TRUSZKOWSKA, A. (2010) Taenia serialis
in a domestic rabbit. Veterinary Record 166, 282
HARCOURT-BROWN, F. M. (2007) Gastric dilation and
intestinal obstruction in 76 rabbits. Veterinary Record 161,
409-414
LORD, B. (2012) Gastrointestinal disease in rabbits
1. Gastric diseases. In Practice 34, 90-96
THOULESS, M. E., DIGIACOMO, R. F. & DEEB, B. J.
(1996) The effect of combined rotavirus and Escherichia coli
infections in rabbits. Laboratory Animal Science 46, 381-385
Further reading
DAVIES, R. R. (2006) Digestive system disorders.
In BSAVA Manual of Rabbit Medicine and Surgery, 2nd edn.
Eds A. Meredith and P. Flecknell. BSAVA Publications.
pp 74-84
OMALLEY, B. (2005) Rabbits. In Clinical Anatomy and
Physiology of Exotic Species. Elsevier Saunders. pp 173-195
SILVERMANN, S. & TELL, L. A. (2005) Radiology of
Rodents, Rabbits, and Ferrets: an Atlas. Elsevier Saunders.
pp 159-230
Self-assessment test:
Intestinal diseases in rabbits
1. Which nematode that is considered to be
non-pathogenic is commonly seen in rabbits?
2. What are the common species of intestinal
coccidia in domestic rabbits?
3. What are the common predisposing factors
involved in caecal dysbiosis?
4. List the antibiotics that should be avoided
in rabbits, as they can be associated with fatal
enterotoxaemia, especially if given orally.
5. List the types of neoplasia that have been seen
Answers
metastatic haemangiosarcomas
adenocarcinomas, leiomyosarcomas and
5. Anorectal papillomas, lymphomas,
cephalosporins and erythromycin
4. Penicillins, lincosamides, aminoglycosides,
suppression of the normal microbial flora
motility, or antibiotic administration causing
immunosuppression and decreased gastrointestinal
gastrointestinal motility, stress causing
3. A sudden diet change altering pH and
Eimeria magna
2. Eimeria perforans, Eimeria media and
1. Passalurus ambiguus
 Downloaded from inpractice.bmj.com on June 29, 2012 - Published by group.bmj.com

Gastrointestinal disease in rabbits 2.

Intestinal diseases
Brigitte Lord

In Practice 2012 34: 156-162

doi: 10.1136/inp.e973

Updated information and services can be found at:

http://inpractice.bmj.com/content/34/3/156.full.html

These include:
References This article cites 6 articles, 3 of which can be accessed free at:
http://inpractice.bmj.com/content/34/3/156.full.html#ref-list-1

Email alerting Receive free email alerts when new articles cite this article. Sign up in
service the box at the top right corner of the online article.

Notes

To request permissions go to:

http://group.bmj.com/group/rights-licensing/permissions

To order reprints go to:

http://journals.bmj.com/cgi/reprintform

To subscribe to BMJ go to:

http://group.bmj.com/subscribe/