Re: rabbit with URT noise

a.bardell — Thu, 09 Jan 2014 11:22:57 GMT

thanks for the advice, v gratefully received!

had a further long discussion with owner about where to go and what to do next and realistic treatment options. owner felt that rabbits quality of life was not good and was worried she would run up a large bill with no good outcome at the end. Money is tight but wants to do what is best for the rabbit.

it was hospitalised with us for 2 days and even after intensive nursing was having to be syringe fed little and often.

unfortunately owner requested euthanasia so can't add any more to original post. Will bear all the advice in mind for the next time

Alexa

Re: rabbit with URT noise

Marie Kubiak — Tue, 07 Jan 2014 14:05:27 GMT

Hi,

rads definitely sound like a good first step but be prepared to intubate rapidly should its breathing decline - check O2 sat on room air first and if saturation is poor then oxygenate and consider delaying the procedure until symptoms are better controlled. I would do laterolateral skull, 30 degree oblique skull views, DV skull plus two laterals and a DV of the thorax. Make sure with the thoracic views the forelimbs are pulled well forward as the musculature can mask a mediastinal mass. I find in rabbits that combined URT and LRT infection is not uncommon and they can have really severe pulmonary radiographic lesions present without clear changes on auscultation. Worth also doing nasal endoscopy to assess for masses, discharge (and its location) and any FBs if possible and collecting deep nasal swabs as a variety of bacteria can be involved with very different antibiotic susceptibility patterns.

Dental pathology, maxillary bone abscessation, nasal FBs, sinusitis and neoplasia can all cause increased URT effort and CT is ideal for assessment where available but rads can be sufficient in many cases. Cardiac disease, thymoma, mediastinal lymphoma, pulmonary neoplasia, pulmonary abscessation, pneumonia and pleural fluid all present with much milder respiratory compromise than you would expect in a cat/dog and can be found alongside an 'incidental' but much more obvious URT infection in a debilitated rabbit.

Even if 'simple snuffles' is diagnosed by exclusion of other differentials and presence of increased sinus opacity it can still be a nightmare to manage effectively - the sinus system has poor drainage and the anatomy happily stores a nice pool of bacterial soup as an ongoing source of infection that flares up when antibiotics are stopped. Long-term steam/nebulisation therapy combined with long-term or pulse antibiotics can maintain QOL and sinus trephination and curettage remain an option for the more enthusiastic owners but I would want to do CT before deciding on this as the right option.

Consider nebulisation for a day or two before sedation, if it isn't critical, to try and clear the more tencious secretions and improve comfort - often they will be keen to eat once they can breathe properly through the nose and then are able to chew without respiratory distress.

Marie