Gastrointestinal stasis

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Gastrointestinal stasis, GI stasis, GI hypomotility or ileus is a serious condition that requires immediate attention. The condition occurs when the gut stops moving, is blocked, or is full of gas.

Symptoms

River the lop pressing her belly against the sofa in discomfort. [source]
Mayhem refused her hay, treat, pellets & veggies, and was taken to Orange County Emergency Pet Clinic. Here is the x-ray that shows dark blobs indicating gas. source
Rey, from Great Lakes Rabbit Sanctuary, pressing her belly to the floor in pain from a lower GI obstruction. The two x-rays show the location.
Chart (c) by "Bonkers Babbities- Flix and Gaga", found on Flix and Gaga's Welfare Posters page. Used with direct permission.
  • Loss of appetite (anorexia) or changes in eating habits. A good way to test this is to offer fresh herbs or a favorite treat.
  • Small to no stool, loose or mucous covered stool or diarrhea.
  • Sitting in a hunched position or pressing stomach against the floor.
  • Loud tooth grinding which is an indication of pain. This is different than the "tooth purr" that indicates pleasure or contentment.
  • Loud GI sounds or complete silence in the stomach. You can use a stethoscope or listen with your ear pressed against the stomach.

Causes

  • Stress. Examples of stressful events include changes in housing, introduction of new rabbits or other pets, recent illness, trauma, or surgery.[1]
  • Dehydration.
  • Lack of dietary fiber. Rabbits whose regular diet consists primarily of pelleted feeds are at higher risk of developing GI stasis as the pellets are usually high in calories (high in digestible carbohydrates), low in fiber, high in protein, and highly digestible.[1] Similarly, rabbits routinely fed large amounts of high-simple carbohydrate, high-fat treats such as nuts, seeds, baked goods, and fruits are also predisposed to GI stasis.[1] Acute episodes of GI stasis and dysbiosis are common following ingestion of a large volume of these treats.[1]

Diagnosis

Gastrointestinal stasis can be usually diagnosed as non-obstructive or obstructive ileus.

Non-obstructive Obstructive
Clinical Signs
  • Gradual onset (days to weeks).
  • Gradual reduction in fecal size and output.
  • Crave fiber.
  • Initially bright; gradual onset of depression and abdominal pain.
  • Mild to moderate dehydration.
  • Sudden onset (24-48 hours).
  • Fecal output stops abruptly.
  • Severe depression.
  • Abdominal pain.
  • Reluctance to move.
  • Symptoms of shock.
  • Severe dehydration.
  • Death in 24-48 hours.
Radiographic findings
  • Compacted material in stomach and sometimes caecum, often with halo of gas.
  • As symptoms progress, entire GI tract gas-filled. Stomach usually last to bloat.
  • Fluid present only late in disease.
  • Fluid and gas present cranial to obstruction.
  • Bubbles of gas in stomach with no halo.
  • If cecal obstruction, fluid and bubbles of air in cecum.

From Keeble, E & Meredith, A. (2006). Rabbit medicine & surgery: Self-assessment color review.

When palpating an affected rabbit's stomach, the stomach usually feels firm and doughy and remains pitted on compression.[1] Rabbits with GI stasis have few or no gut sounds.[1]

Treatment

You should seek immediate veterinary assistance if your rabbit has not eaten or passed stools in the past 12 hours or is exhibiting other symptoms of GI stasis. Your vet will provide proper treatment and care. If left untreated, GI stasis can be fatal in 48 hours.

The key principles in the treatment of GI stasis are the following:[1] [2]

  • rehydrating the rabbit and stomach contents
  • restoring appetite
  • correcting electrolyte imbalances
  • stimulating gastric emptying
  • promoting normal gastrointestinal motility
  • softening and lubricating impacted food and hair
  • alleviating pain
  • providing nutrition
  • treating any underlying disorders

Rabbits should receive fluids either intravenous, intraosseous, or subcutaneously, depending on the severity of dehydration. Stomach contents can also be rehydrated by assisted feeding with a syringe.[2] A popular commercial product for this purpose includes Oxbow Critical Care for Herbivores. Other alternative commercial brands can be found at First aid for rabbits#Syringe feeding. If these formulas are not available, blended pellets soaked with water or an oral electrolyte solution can be used.[2] Pureed vegetables or baby foods are also an option, but these foods are not sufficiently high in fiber.[1] Force feeding these formulas can help prevent hepatic lipidosis, which can develop quickly in a rabbit with a negative energy balance.[2]

Rabbits with GI stasis usually have mild to severe gut pain, especially if the intestines are distended with gas, and will not eat until the pain is alleviated.[2] Appropriate drugs include buprenorphine and a nonsteroidal anti-inflammatory drug (NSAID) such as meloxicam or carprofen.

GI prokinetics such as cisapride and metoclopramide are commonly used for GI stasis treatments. The use of intestinal prokinetic agents is somewhat controversial, but anecdotal evidence suggests that they may be beneficial.[2]

  • Cisapride is readily absorbed from the GI tract and promotes gastric emptying, increases gastrointestinal and colonic motility.[2][1] It acts on both the foregut and hindgut and does not increase gastric acid secretion.[1] The effects last for 4 to 10 hours and stimulates appetite, especially for fibrous foods such as grass or hay.[1] Cisapride is contraindicated in patients with mechanical gastrointestinal obstruction, haemorrhage or perforation and can have fatal interactions in rabbits with antifungal drugs such as ketoconazole, itraconazole or miconazole by causing fatal cardiac arrhythmias.[1]
  • Metoclopramide promotes gastric emptying and increases gastrointestinal motility in rabbits, and it does not affect the hindgut or gastric, pancreatic or biliary secretion.[1] Like cisapride, metoclopramide is contraindicated in rabbits with a GI obstruction.[1]

If evidence of dysbiosis is present, antibiotics such as enrofloxacin and trimethoprim-sulfamethoxazole may be needed. If enterotoxemia is suspected, metronidazole should be administered.

Liquid paraffin can be used to soften and lubricate impacted stomach or cecal contents and should be administered with care (preferably mixed with food) as it is easily aspirated.[1]:321

Care should be used when protein-digesting enzymes such as pineapple for bromelain and papain. They can be very irritating to the oral and gastric mucus.[2] The risk of gastic ulceration is increased in anorexic rabbits, and use of these enzymes can make this a bigger problem.[2] Additionally, the recommendation that these products can dissolve hair is false, and the success of pineapple juice as a remedy may be due to the introduction of liquid rather than the enzyme.[1]

Petroleum laxatives such as Petromalt and Laxatone are of questionable value as well.[2]

In the very rare case, a dehydrated mass of material in the stomach can form a solid immovable mass and surgical intervention may be necessary. Prognosis for a successful outcome is greatly reduced as anesthesia, pain, stress, and manipulation of the intestinal tract all exacerbate GI stasis, and complications of hepatic lipidosis are a common cause of death in these rabbits.[2]

At-home treatment

For at-home initial treatment when you first notice symptoms, you can do the following:

  • Check the temperature of your rabbit rectally. Normal rectal rabbit temperature should be 100.5°F-103.5°F (38.1°C-39.7°C).[3]
    A rabbit buried in blankets with some vegetables in front of her face while she was lethargic from an extremely low body temperature during a stasis episode.

    A temperature below 100°F means the rabbit is starting to go into or is already in shock. Rabbits will be very lethargic with decreased responsiveness to stimuli. Immediately start warming up your rabbit with heat support. A heating pad, a plastic bottle full of hot water, a microwaved sock full of rice, or a SnuggleSafe disc should be wrapped in a towel to prevent burns. If you do not have any heating accessories, you can microwave a towel or blanket for 30 seconds to temporarily heat it up, or just wrap your rabbit completely in a towel or blanket. Portable hand warmers are also extremely useful under towels and blankets and should be moved around the body every 5-10 minutes to warm them up.

    A very high temperature above 106°F also needs immediate attention. You can cool down your rabbit by putting the rabbit in a breezy area and carefully wetting down the ears, their main thermoregulatory organ.

  • Check the consistency of your bunny's belly. A dehydrated rabbit will feel doughy. A normal rabbit will have the consistency of a balloon. A bloated rabbit will feel like an overfilled balloon. If your rabbit is bloated, please find your nearest emergency vet and start treatment promptly.
    Long Island Rabbit Rescue Group. (2021). GI Stasis VS Bloat
  • For an acute gas attack, feed 1 to 2 cc of infant simethicone (20 mg/mL suspension) to your rabbit (all sizes) every hour for the first three hours, then every three to eight hours.[4] This product is easily obtainable in the baby sections in a drugstore, pharmacy, or supermarket as a liquid suspension or 125 mg gel capsules. A bunny can safely receive the contents of half a capsule at the rate described above.[4]

    Simethicone has no known drug interactions and is not absorbed through the intestinal lining. It acts only on a mechanical principle: it changes the surface tension of the frothy gas bubbles in the gut, joining them into larger, easier-to-pass bubbles.[4] While this treatment alone will not return function to the intestinal tract, it appears to have no ill effects.[1]

  • Try to keep your bunny hydrated to help break up any masses in the stomach. Offer up herbal non-caffeinated teas and cold wet fresh vegetables nearby within easy access if your rabbit does not seem to want to move.

    Refrain from force feeding any water directly with a syringe as liquids are easy for rabbits to aspirate and cause more serious issues.
  • Making sure that the stomach is not hard with an obstruction, reach under your rabbit's belly and gently massage your rabbit's abdomen to help stimulate the muscle and break up gas bubbles. Pocket vibrators and vibrating toothbrushes are also great for this purpose. Be sure to keep any massage gentle as an aggressive massage can cause torsion, internal bleeding, or rupture organs. Elevating the hindquarters a few inches can also help any gas pass more easily.[4] In addition to the videos below, also check out Massage for rabbits#Belly massages for more resources.
    Howcast. (2013). How to Help a Rabbit with Gas Pain
    The Residents of Fairy Castle Farm. (2014). Gentle Bunny Tummy Massage
  • Keep a quiet environment away from predators and barking dogs.

For the following tips, only feed without a veterinary visit if your rabbit is swallowing:

  • If your rabbit shows no interest in drinking or eating vegetables on their own, you can syringe water or herbal non-caffeinated teas into their mouths directly.
  • If your rabbit has not eaten in over 8 hours and shows no signs of bloating, assist feed 10-20cc (1-2 Tbsp) of Critical Care, pellet mash, or pumpkin puree to make sure there is food and fiber in their system for calories and to encourage digestive movement.
  • A gut motility drug such as cisapride (Propulsid) or metoclopramide (Reglan) can be given to get your rabbit's GI tract working again only if there is no blockage. The dosage is 0.1cc per pound of body weight.[5] You may also use ranitidine (Zantac), an over-the-counter drug, as a pro-kinetic in an emergency at a dosage of 2-5 mg/kg orally.[6] It also has anti-ulcerative qualities and useful in stressed rabbits.[7]

    For ranitidine, you can crush either one 75mg tablet in 3.3cc of water OR one 150mg tablet in 6.6cc of water. 0.1cc should be given per pound every 12 hours or every 8 hours if dire. The solution can be stored for up to a week.

    In September 2019, the carcinogen N-nitrosodimethylamine (NDMA) was found in some ranitidine products. As of April 2020, the FDA has requested the removal of all products containing ranitidine, both tablet and liquid.[8] The EU and Australia has also suspended usage and distribution of the medicine. If using ranitidine for your rabbit, please proceed with caution.

Extra resources

X-rays

Contrasting X-ray images using diatrizoate.

Problems

"Rabbit intestines have been noted to be difficult to visualize in radiographs due to thin walls and surrounding structures obscuring edges. A recent study determined the dose of an iodine containing radio-opaque contrast agent, diatrizoate, and timings of radiographs to better visualise passage though the intestine and improved visualization of the gastrointestinal system. It was found the 7 ml/kg PO dose achieved contrast media in the ceceum after 45 mins. For more information about this study, please read the recent volume of Journal of Exotic Pet Medicine." - Association of Exotic Mammal Veterinarians

Dierig, J., Fehr, M., Eckert, Y., Hetterich,J., Thole, M., Rohn,K.,Reuschel, M. 2021. Diatrizoate contrast agent study for luminal patency and visualisation of the gastrointestinal tract in healthy rabbits (Oryctolagus cuniculus) and its influence on selected blood parameters and fecal quality. Journal of Exotic Pet Medicine. 37.8-15.


Further reading

See also

References

  1. 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 Varga, M. (2013). Textbook of rabbit medicine. (2nd ed.).
  2. 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 Quesenberry, K & Carpenter, J. (2012). Ferrets, rabbits, and rodents: Clinical medicine and surgery. (3rd ed.).
  3. House Rabbit Resource Network. (2001). Body Temperature. Retrieved 17 Apr 2020 from http://rabbitresource.org/body-temp/
  4. 4.0 4.1 4.2 4.3 Krempels, D. (2005). GastroIntestinal Stasis, The Silent Killer. Retrieved 8 Mar 2016 from http://www.bio.miami.edu/hare/ileus.html
  5. House Rabbit Society MD, DC, & NoVA. (n.d.). Help Me Make It Through the Night. Retrieved 18 Sep 2020 from http://rabbitsinthehouse.org/newsletter/HRS-HelpMeMakeIt.pdf
  6. Carpenter, J. (2010). Diagnosing and treating gastric ileus/stasis in rabbits (Proceedings). Retrieved 25 Feb 2019 from http://veterinarycalendar.dvm360.com/diagnosing-and-treating-gastric-ileusstasis-rabbits-proceedings?id=&sk=&date=&pageID=2
  7. Saunders, R; Clark, M. (2012). Managing GI stasis in rabbits. Retrieved 25 Feb 2019 from https://www.vettimes.co.uk/article/managing-gi-stasis-in-rabbits/?format=pdf
  8. U.S. Food and Drug Administration (2020). FDA Requests Removal of all Ranitidine (Zantac) Products from the Market. Retrieved 22 Sep 2020 from https://www.fda.gov/news-events/press-announcements/fda-requests-removal-all-ranitidine-products-zantac-market