Impacted rabbit

RE: Impacted rabbit

Rob Loxley — Sat, 28 Nov 2015 12:53:13 GMT

[quote user="Silvia Maldonado"]Cisapride was mentioned, but talking to my boss about it, she tells me that cisapride is now illegal in the UK and not available anymore[/quote]

Last I looked you could get cisapride liquid from Summit Pharmaceuticals as a special

RE: Impacted rabbit

Robin Grimmer — Sat, 28 Nov 2015 11:12:41 GMT

Ranitidine is a good prokinetic in rabbits, 6mg per kg bid. We also give metoclopramide concurrently but I suspect the Ranitidine is more effective.

RE: Impacted rabbit

Martin Atkinson — Sat, 28 Nov 2015 09:53:20 GMT

Notwithstanding earlier discussions on this I find metoclopramide to be effective, but I have never used cisapride. It is however as far as I know still available from Summit Pharmaceutical in tablet form as a special.

RE: Impacted rabbit

Silvia Maldonado — Sat, 28 Nov 2015 09:44:47 GMT

Hi, all,

Recently I heard a webinar about small mammals, and one of the discussions was in regards to best prokinetics in rabbits. Cisapride was mentioned, but talking to my boss about it, she tells me that cisapride is now illegal in the UK and not available anymore. Anyone has more info? Also, if we can get cisapride from abroad, can we still use it in the UK? In other words, is it totally illegal to use it? Also in pets? or just difficult to get it?

Re: Impacted rabbit

Hannah Wynne Richards — Mon, 05 Jan 2015 15:12:34 GMT

Sorry to hear that. It's all bad news today.

Wynne

Re: Impacted rabbit

Matt Hilary — Mon, 05 Jan 2015 14:41:03 GMT

Update: hospitalised and treated medically. Improved initially and passed approx half impacted faeces (based on abdominal palpation) 36h post-admit. Went downhill that night and died morning after.

Didn't get as far as xrays for financial reasons but on discussion with owner did sound as though possible stress aetiology rather than underlying disease.

Re: Impacted rabbit

Matt Hilary — Wed, 31 Dec 2014 17:14:57 GMT

Many thanks for all the advice - much appreciated as always.

Re: Impacted rabbit

Martin Atkinson — Wed, 31 Dec 2014 17:00:34 GMT

[quote user="Marie Kubiak"] I would avoid liquid parafiin - coating the husk of ingesta in a relatively water impermeable material won't help with rehydrating and breaking it down so it is only of use if the impaction is already small enough to pass. [/quote]\My experience with liquid paraffin is good. I'm not using it really as a laxative but a relatively small amount can lubricate the impaction and make it easier to (carefully) digitally break it up.

Re: Impacted rabbit

Martin Atkinson — Wed, 31 Dec 2014 17:00:16 GMT

Re: Impacted rabbit

Michael Woodhouse — Wed, 31 Dec 2014 16:46:04 GMT

Is there any merit using oral magnesium sulphate (or similar) to soften the mass? That's what you'd do with a horse with a pelvic flexure impaction.

Re: Impacted rabbit

Hannah Wynne Richards — Wed, 31 Dec 2014 16:39:58 GMT

Another saying thanks

Wynne

Re: Impacted rabbit

Louise6732 — Wed, 31 Dec 2014 16:38:41 GMT

Thanks for the comprehensive answer Marie, I'm printing this out for future reference! That's what I love about this forum :-)

Louise

Re: Impacted rabbit

Marie Kubiak — Wed, 31 Dec 2014 14:54:01 GMT

The caecal impaction is a secondary problem - management is oral fluids (mixed with fibrous syringe food to provide fibre to stimulate normal GI motility) plus IVFT to rehydrate the lump of dried ingesta and allow it to move through. Lactulose's osmotic effects will help a little with icreasing fluid available to rehydrate the lump. I would avoid liquid parafiin - coating the husk of ingesta in a relatively water impermeable material won't help with rehydrating and breaking it down so it is only of use if the impaction is already small enough to pass. An enema is unlikely to be of much help and the rabbit colon is thin walled.

Metoclopramide is unlikely to be of benefit for a lower GI problem and can cause GI discomfort from spasmic effect so ranitidine alone is likely to be just as effective as this works primarily on the lower GIT. I would use injectable ranitidine in inappetant cases with no faecal output (if you are able to get hold of it with the variable availability). I'd continue buprenorphine for analgesia - there is evidence that is has no constipatory effects in rabbits and if it manages pain in your patient then you don't need to consider NSAIDs in a patient that may have dehydration/gastric erosions.

The primary problem is an altered GI motility that has lead to ingesta remaining static in the caecum and progressively drying out. The original factors in GI hypomotility are broad and can include any psychological stress, any painful focus, any debilitating disease and any dietary failings. On this basis it makes sense to look at further investigation if the rabbit isn't improving as your primary cause needs addressing. I would consider a conscious abdominal Xray now to look at the reproductive and urinary tracts in particular given the history and think about sedation for full skull set and thorax rads later on if needed.

Marie

Re: Impacted rabbit

Hannah Wynne Richards — Wed, 31 Dec 2014 14:14:27 GMT

I don't think an enema would help - the problem is too far forwards.

Wynne

Re: Impacted rabbit

Robin Grimmer — Wed, 31 Dec 2014 13:56:04 GMT

Cisapride if you can get it. Is available again. Has more action on the large intestine than metoclopramide.

Re: Impacted rabbit

Martin Atkinson — Wed, 31 Dec 2014 13:13:04 GMT

I have found liquid paraffin to be more useful than lactulose at the outset but be careful how you administer it to avoid inhalation. Then gently massage the impaction so long as it is not rock hard or painful. On the basis of the advise given me by a dinovet many years ago: 'lubricate before dynamite' i.e. don't given an enema before things are mobile but I don't believe I've ever given an enema to a rabbit. If it is in pain then I would give meloxicam because it isn't going to get better if it is too uncomfortable to eat.

An X-ray may give you a prognosis but it is a brave man who will do any gut surgery on a rabbit. However a serum glucose may be of help. Hyperglycaemia > 20mmol/l is associated with a poor prognosis.

Re: Impacted rabbit

Hannah Wynne Richards — Wed, 31 Dec 2014 12:38:00 GMT

I'd syringe water in as well - get it into the gut. Good luck

Wynne