Well, greetings from Kansas State University, Manhattan, Kansas, and thanks for joining this, this webinar. Just as a bit of orientation, Kansas is in the middle of the United States, and Manhattan has a population of 55,000, so we're a small town, and includes around 20,000 students. I'm certainly honoured to have been invited to participate in the 2021 Congress, and I've been fortunate to have also participated in other congresses and conferences throughout Latin America, many in Mexico as well as Ecuador, Colombia, Peru, Chile, and Argentina.

And whenever I've travelled, I feel that I've learned more from the veterinarians at these conferences and I have taught them. And also to experience the history and culture of Latin America has been really awesome. But like everyone else, it's unfortunate that this conference is virtual, but at least we are having one, and so that part is exciting.

So again, thanks for for attending. So, so practitioners are being asked to provide, you know, better health care for the rabbits. Here it's certainly very common species.

And this is a very common issue that we face, anything that involves the GI tract of these animals. I always thought this was a good way to start a a lecture because I think it's humorous. And it says that the human brain starts working the moment you are born and never stops until you stand up to speak in public, and that's true even if it's virtual.

So, domestic rabbits. Again, they're extremely common pet, very popular here, Ararictologous juniculus. They're in the order Lagamore, and they are descendants of the old world rabbit of Western Europe and the Northwest Africa.

There's about 50 breeds that are recognised in the United States. And again, they are a popular pet. Why is that?

Because they're small, they're quiet, they're, they, they're clean, take care of themselves, and basically they're relatively easy to care for. But they can be challenging in many ways, so some of the medical and surgical issues, can, can be challenging. This is just some, some of the breeds and actually many of these are just colour morphs of the of the 50 breeds.

Rabbits have evolved as a prey species. They're stoic when they're stressed and stressed animals are just more prone to health problems, as you all know. So, we'll make a few comments on their digestive physiology.

Rabbits are herbivorous, and herbivorous animals, maintain bacterial populations in their GI, primarily in their segum, for fermentation of selected plant materials. The GI system combines a simple stomach with hindgut faecal fermentation. So this is similar to the horse in a way, except the horse is more colonic.

The gastric transit time is 3 to 6 hours. And dietary fibre stimulates gut motility. And the teeth are developed for a high fibre diet, and so they are constantly growing, and rabbits will chew with about 120 jaw moves, movements per minute with a lateral motion.

And that's important when you're considering that their diet is largely, or should be largely fibre. So in rabbits, perstosis propels the the large fibre particles to the colon quickly. And it forms the firm pellets.

So why is that significant? Because rabbits are small and they just can't store large amounts of fibre in it, so it goes quickly. The small fibre particles travelled backwards from the colon to the secu, the ferment bat that we'll talk about.

And in the sum, the small fibre particles and fluids undergo fermentation, and it produces volatile fatty acids and, and other nutrients. So this fermentation vat is where millions, and some may say, you know, trillions of gut bacteria digest the undigestible. A few other characteristics of the GI anatomy.

They have a very large abdominal cavity. The GI tract is long, 10 to 20% of the body weight, and the stomach contains 15% of the ingesta, and the stomach is very thin walled. It's one of the thinnest actually of any of the animals.

Rabbits lack the neurophysiological mechanism for vomiting, therefore, they're unable to vomit. And they have a polaris that's easily compressed by the duode. And why is that?

It's because the duodenum exits from the stomach and a very sharp angle. The small intestines are 12% of the GI volume, and much of the digestion occurs here except for the fibre and cellulose, which will occur in the secu. The ilium ends ends at the secum and the colon or is expanded.

It's called the sacculus rotundus, and this actually contains lymphoid tissue, very unique to rabbits, although there's also some lymphoid tissue in the distal secu. They have a large thin walled secum, which holds about 40% of the ingested, again, this is for hindgut fermentation. And it's the most prominent organ of the abdominal cavity.

They have circulations and bands, which kind of increases surface area. It also contains bacterios and, and other bacteria, gramme negatives, grandpas protozoa and and some clostridium again and and an. They can absorb the volatile fatty acids, some amino acids and vitamins here.

And they can also pass some of these products in the yo tropes, which we'll talk about in a few minutes. So this is our friend, the rabbit, and they have constantly growing teeth, so they have to keep moving their teeth to grind their teeth down. Hence, they need fibre as well just for their teeth, as well as for the GI system.

Going down to the oesophagus, to the stomach. And the stomach has muscular contractions and it, you know, mixes the food with gastric fluids. It's basically sterile because that has a very low pH.

Over here, we're gonna have the pyloris, which as you can see leaves at a at a sharp angle. I can get my arrow moving here. Small intestines, duodenum, jejunum, and illium, and the small small intestines is where the major part of the digestion takes place, .

Some sugars, most starches, and 90% of the proteins are actually absorbed in the small intestine. Then we go to see them. And this is the site of cellular digestion, where the dense small fibre particles go and you have fermentation.

And, and the fermentation is occurring by the bacteria in the protozoa. So they're digesting the small fibre cellulose, and proteins that weren't digested in the small intestines. So basically we say that rabbits are a large sum covered by fur and a will to die, although that's not as true as it used to be because we have so many other medical advances for rabbits, and we say that, you know, everything eats rabbits except tissue paper.

So fibre is in their diet should be, you know, greater than 15 to maybe 16% approximately, because that promotes motility, which is very important in the rabbit. But if you increase it too much, you know, 21, 22%, for example, it, it, it reduces palatability. And so, this fibre in the stomach, it provides large particle size.

You get a lattice-like ball and that permits the gastric acid to penetrate and and digestion of some of the contents. Whereas if you have a high energy diet, a high carb diet, and low fibre diet that may increase susceptibility to mucoid neuropathy. So that is in bacterial basically anitis.

And there may be other enteric diseases. The pelican diet should also contain about 13 to 18% crude protein. Zika tropes are really pretty interesting.

They're specialised faecal pellets produced in the Segum. They are smaller high density portions of ingested that cover the mucus, and they're still fermenting, as, as they're, you know, consumed and, going into the stomach until the mucus will break down and then, most of these other nutrients are then absorbed in the small intestine. Cros contain twice as much protein, increased volatile fatty acids, increased vitamin B, and a decrease in fibre of, you know, usual faecal pellets that produced at night and early morning, and that's where they are, consumed.

It's so, so it's an important, strategy for efficient digestion of, of food items and protein. Actually it's an important adaptation for animals in the wild, where they can consuming suboptimal sources of of of vegetation. The pH of the stomach is less than 2, so it's very acidic, and this will neutralise basically all bacteria that are ingested, you know, even with the strops.

So that kind of raises the question of probiotics that we will talk about briefly. So probiotics probably have really minimal role in, in, in mature rabbits because, bacteria just can't pass the stomach. So low fibre diets that many owners feed may result in first, a reduction in intestinal motility.

Prolonged SEO retention time, this results in a, a change of SCOPH. Thirdly, you know, reduction in feed intake. It may predispose to diarrhoea, and that can be very serious, life threatening even, and it may change the normal floor but can also have adverse effects on rabbits.

But high fibre diets. They stimulate normal digestion. Absorption peristalsis and and excretion.

So that is the that is the goal of our diets, provide them a high fibre diet. So what are some of the problems with a high carbohydrate diet, such as in many pelleted diets? Well, they contained excessive glucose, which allow clostridium and other bacteria to proliferate.

Can result in excess volatile fatty acids. Which will lower the the sequel pH. That will inhibit normal flora.

And you'll get proliferation of pathogens and production of gas and toxins can be very painful and potentially life threatening. And then thirdly high carbohydrate diets inhibit release ofmoolin which induces peristalsis. So this will further slow down the GI motility.

So the gastric pH changes from 5 to 6.5 in neonates and, and why is that important to the neonates because that permits the establishment when they're young is born of the bacterial flora and in the yum, and that's, that's, that's what we want. So bunnies therefore can certainly take probiotics because the bacteria can pass the stomach because it is higher.

Aerobes such as bacterios, which is the most common, Clostridium is present in some as a gramme positive. They may inhabit the the GI, but by and large they're in this in the secu of the weanling and adult, although the stomach and GI really are generally free of bacteria. Lactobacillus, which you hear about in small animals.

May be present, but oftentimes it is not. So therefore, when a rabbit's GI tract is compromised, some common rabbit enteric organisms can overgrow, becoming invasive, and produce toxins. So the gut sum here contains bacteria as well as some yeast, fungi, and some people have speculated they contain, you know, trillions of organisms.

Not sure who's doing the accounting, but whatever it is, they have a lot of them. And, and, and this provides capability to digest food items. Over they can get energy.

And some bacteria can also confer some immunity, especially to the neonates. So captive management can influence the multibiome, and so we need to know which factors can have adverse effects on the gut floor of the rabbit. It's important to identify.

These factors so that we can promote healthy microflora in the species. So, what are some of the keys to rabbit nutrition? So this is, this is very important.

The first is we want to make sure that we provide a premium high fibre diet, greater than 70%, probably much higher. And it's good to offer a variety of hays for optimum health. Next, the high fibre uniform pellet.

You know, less than 25%, and most of these pellets contain a large amount of Timothy hay as well, so that part is good. But one reason we like to have the the pellets. And again, that's gonna be just a small amounts, is that some of the cuttings are like Timothy Hay, maybe less nutritious later in the season.

So this is a way of making sure that that the rabbits can get sort of an optimum diet with some other nutrients added as well. Fresh greens. Generally less than 5%, and, and dried plants are also good.

Treats less than 5%. They should be low sugar, high fibre treats. And fresh clean water at all times.

So water should be changed every day and it should obviously be checked, especially if it's in a in a container with thisipping container to make sure it is functioning well, and the container should always be kept clean as well. So one of the questions people might have, well, what is hey, we all use it, but you know, actually, what is it? Well, it's, it's a dried, preserved plant product and with proper storage, it can retain its fresh smell and palatability for years.

It has a number of characteristics. The colour, the smell, taste, and the feel are all affected by how, how the hay is grown, how it is cut, ba, stored, and how it is packaged. It's also important to know that you don't want to feed any musty hay or any mouldy or dusty hay to the rats.

So make sure it's a high quality. So what are some of the grass hays that that we commonly use and that we recommend? Well, the first and foremost is Timothy.

I don't know if Timothy is the best hay, for example, but I think it's the first one that was marketed and it's most widespread use, and it's very good. So it's the most popular, readily available in in in our country and pet stores, and I think throughout Latin America wherever I visited, I think they have that as well. It's a long strand of of fibre.

It's low in protein. Calcium and energy, and it's harvested 2 to 3 times a year depending on climate. Now it's only produced in certain parts of, of this country and actually in only certain parts of the world.

I'm not sure where in Central and South America it's produced, but I'm sure it's available, not I'm sure it's available, at least commercially, being shipped in. And then orchard hay. Orchard hay is nutritionally similar to Timothy hay.

It's a soft texture. It has a sweet smell taste, sweet smell and taste. Rabbits do like it.

It has a high palatability to to some of them. So if you're feeding the Timothy and seems like that they are consuming as much as you like, but you might just alternate with orchard. Some people will even combine them.

And OK. It's also a very good source of, of fibre. And there's others as well.

There's prairie hay and you can even use it. Cut grass from from fields as long as there's been no no spraying on them. So those are the grass hays.

So how do we distinguish that from a legume hay? So the legume hay that people are very familiar with is alfalfa. OK, so it is not a grass.

It is in fact a lit. It's higher in protein, calcium, and energy. And so, when would this be used?

Well, it's very good for the young and the growing animals because they need higher protein, calcium and energy. It can be a treat for adult animals. And it can be an appetite stimulant in senior animals or in animals that are sick or not eating regular food.

But it would be for a short time, for short term. Because you can have issues with the high protein and with the calcium and and with too much energy. So hazes are made up of two types of fibre, and you're probably familiar with this.

The larger particles that are indigestible fibre for proper gut motility, very, very important. We said that earlier that these large Particles are important for going through the system very rapidly and pushing through. The small particles are digestible, they they can be fermented, and this fibre provides essential nutrients for the scum and for normal bacterial flora.

This picture is just showing harvesting Timothy Hay in North America. So what are some of the nutritional benefits of hay? Well, first, It stimulates gastrointestinal peristalsis.

It discourages the bad bacteria. So it encourages the good bacteria. And it maintains the pH balance.

It also aids in proper dental motion and frequency. And it helps prevent mal inclusion. Again, because the teeth have to keep grinding against each other and they need the fibre to do that.

And it's essential for weight weight control. And lastly, it stimulates water intake. The water needs for rabbits are very high.

It can be, 100 to 120. Some places I read say maybe even 150, but that's very rare you read that. But it is very high compared to most other animals, so there, water needs, the water intake is, is quite high.

Well, there's also some psychological benefits of hey. First, we can encourage natural behaviours. And by that we mean and stimulate foraging and grazing, and that's important in captive environments especially.

It can be mentally stimulating. And that is important because again, you have rabbits in captivity, they're not roaming in the wild. Most of them are defined in small areas.

And so they can develop some negative behaviours. And this just decreases boredom, and will decrease the development of negative. It increases activity level of them.

It provides a sense of security, since even in the wild, they are eating food much of the time. And basically a pet that lives and enriched life is a healthier, happier pet. So that should be emphasised.

So this is really important. How do you feed rabbits or what do you feed rabbits? Whenever I have students on a rotation, I always ask them, what are you gonna tell a client?

And they're gonna say, oh we're gonna tell them they they largely hate and then some pellets, some other thing. I said, well, that is, it's true, but what is largely hay mean? Is that 50% of the diet, and even if you say it's, it's 75 or 80% of the diet.

What does that mean to a client? What does it mean to you? What does it mean to me?

It doesn't mean a great deal. So I tried to tell the students that they really need to quantify the diet for the clients, really spell it out. And so what many of us will say is rabbits should be fed a quarter of a cup of pellets for 5 pounds or Latin America would be kilogrammes, I think 2.3 kilogrammes, a quarter of a cup, and you can divide that into two meals, so it's really 18 of a cup twice a day.

That's not very much. And they only need it maybe 5 days a week. They don't even need it.

What else? Well, You want to feed them a lot of loose hay, OK? And this is a mixed grass hay, the tenantee oak, prairie hay, high quality dried grass clippings.

Because this again will promote normal GI function. Normal dental activities, dental health, and prevent boredom. And then alfalfa, well, alfalfa can be provided during the growth stages and then discontinued.

It's high in protein and calcium. So again, this is kind of the diet we're talking about. So, you know, a quality pellet is, is, is an important part of the diet.

It should be balanced. It should be complete. And it just reduces the chances of a rabbit just selecting certain food items if a, if a, if a client happens to be given a variety of.

So I'm not exactly sure what is available in in Ecuador, Central and South America, but these are just some of the products that we get here, just go to a pet store and this is Western Timothy, this is OK, orchard pay, and so this is the stuff that can be purchased, commercially and they have other brands, but these are all good sources of fibre. You also want to supplement with chopped, dark, fibrous leafy greens and vegetables, or about 5% of the diet or so. So that would be like a cup or two.

Daily. And so that would be good. And this is just a list of some, some that are recommended, there are certainly others that you can check.

There's some you want to avoid, those that are high in calcium, spinach and stuff, but these are all quite good. Iceberg lettuce, for example, has no nutrients, so that's not on the list, but romaine lettuce, would be fine as well. And some people say, well, how about fruit?

Well, a small amount of fresh or dried fruit, a couple times a week, just bite or two, and they don't even need that actually, a better treat might just be a hay-based treat, something like this. This is oats, but it's in a different form. And, and so that may, you know, be.

Give them a little variety, a little diversity and still be be healthy for them. And the last comment is really important. Make sure that you feed these guys that that you make any changes very gradually.

They have a very sensitive GI system and so if you all of a sudden try to abruptly change their diet, you, you could get this meiosis or disruption of the normal floor kind of issue. So how about some comments on feeding for life stages? Well, growing rabbits and females in late gestation, they can consume twice as much food as as an adult at at maintenance, and that's important to know.

And, and those are pregnant females, . May have a reduction in food intake weekly. And the lactating females, they consume 3 times as much maintenance.

So you gotta make sure that there's fibre there at all times and you'll also probably want to increase, . Somewhat, some of your pellets that you're getting. And other veggies.

So, obviously this we're not not gonna focus on very important health issue and that's the rabbit, GI syndrome. So trico beours, so those are hair balls, and they can easily collect in the stomach. Matter of fact, it, it also occurs in normal rabbits, like normal like wild rabbits, but they're using just they're small in captivity that can get get quite large if you have a lot of issues that we'll talk about.

And so, gastric stasis and ileus, often results from the hyper motility, that can occur, and we'll talk about that some somewhat as well. So what are some of the causes of, of, rabbit GI syndrome? Well, it's multifactorial.

So first, low fibre diet, we've talked about that. For the past 20 minutes or so. So given a low fibre diet can resolve in GI issues.

They have a small hyloric sphincter, OK? And the duodenum exit at a at a acute angle, very sharp angle, and so that can add to this syndrome. They cannot vomit, so they, you know, they're consuming hair and other stuff, and but they can't vomit it up, so they're gonna have to pass it some way.

They have a myoelectrical initiation of peristalsis that occurs in the duodenum of changing them. So if food isn't passing from the stomach, there's no stimulation in the GI or peristalsis, which is, you know, contractions of the, of the intestine. Excessive grooming is a real problem, especially in in captive rabbits and also in rabbits that aren't doing well or have some other health issues, they just keep not much to do, boredom, and they're do excessive grooming they getting too much air in their stomach, and dehydration can also exasperate the issue.

So, there's other causes as well. Be caused by stress, whenever issues that the client may have at their house at that time can be stressful, maybe. Animals added, dogs or cats, .

Pain can be a real problem. Rabbits don't take pain well at all. And things even like molar spurs and you can see dental issues here that can cause pain.

Any disease, liver disease or kidney disease, whatever it is, can cause Intestinal issues and then of course, gastrointestinal blockage will certainly cause acute issues. So gut stasis though is it's a symptom. It is not a diagnosis.

They can be painful. It can be very painful actually and potentially fatal. So as interstitial fluid grows, you know, flows into the gut, and animals dehydration, and that's the problem.

Then there's a reduction in the absorption of electrolytes and electrolyte derangement. So you want to make sure that you obtain a very thorough history. I ask him about the appetite, the faecal production, the hay.

So what is the diet overall? And observe the patient, we will, frequently put them on the floor. When we're right even before examining them, at least during the process just to see if they can move OK, if they look bright and alert, or if they're not moving or they appear hunched over.

Physical examination is obviously very, very important. And a patient of the guts, see things are moving, so that is important, so abdominal palpation. And again you want to be aware of potential dysbiosis, which is no disruption of the normal floor increase of E.

Coli, we said, increase the lodium in some cases at the present, and all this can result in life threatening diarrhoea, you know, neurotoxin. So potential dysbiosis can be more serious than this gut stasis. So what are the clinical signs here?

Some things can get over the phone actually. Anorexia, so they're not eating, they're not eating much, they're not drinking much. And this is a really important clue, production of very small or no faecal pelvis.

So if you're talking to the client, ask them if they are producing normal pellets in normal amounts, this is normal, kind of moist. These are hard dried pellets, and it's very characteristic of this syndrome. And then, depression, they might be depressed.

They have other signs too. They may have weight loss although you haven't weighed them previously and the client probably does not, you may not notice it. It may be gradual, so the clients may not notice it.

Pain may be present, and may be hunched over. They may have tooth grinding and abdominal tenderness on palpation. Maybe some abnormal intestinal sounds.

Many times when we have this syndrome, there's just no sounds. If you have acute caloric obstruction, then they are really depressed. They are bloated, very, very painful, dehydrated.

They have a low body temperature in most cases, and they may be in shock. This is an emergency situation. And it can result in death.

And that can be associated with hepatic lipidosis, clo clostridial overgrowth and production of toxins. So, this syndrome is, is a challenging problem, and failure to, to recognise it and to correct the problem can result in a downward spiral of the patient. So it's very life, life threatening.

So what is this escalating events well? You have a rabbit up here. It may be on a low fibre diet very commonly, stress, other disease, and that results in a decrease in GI motility.

Then it continues to inhabitants. You can have an imbalance of scal flora. And dehydration.

With that, again, you're changing the the scal pH. You can then have an overgrowth of Clostridium or other organisms. They can produce gas or toxins, possibly.

You get GI pain and then rabbits don't take pain well. A decrease in the motility and further anorexia. And then If you start having hepatic damage lippidosis and that can result in death.

So how do we diagnose this? Well, you need a a a minimum database. History that we've talked about.

Diet, the clinical signs we've talked about the decrease in faecal production, anorexia, the dry hard faeces that are produced. Physical examination, you know, with a patient, with palpation. Radiography, very important, tool.

CBC and serum chemistry, so that's important to rule in and rule out. Contributing diseases. And very rarely do we have to do an explorator laro.

This was done 30 or 40 years ago, and many of the rabbits would die from that or following that, and this is very rarely needed anymore unless you know you have like obstruction because we can get them through this with aggressive medical therapy. Body temperature is important, OK? With the onset of shock, rabbits become hypothermic, bradycardic, and hypotensive.

So always try it in these conditions, get a body temperature. Because the onset of shock, the body temperature goes down. So a body temperature of 98 to 99 degrees, suggests that the rabbit is an early stage of shock.

The normal temperature should be about 101 to 104. And body temperatures below 98 or where you guys are at 36.7 °C, indicates severe life threatening shock.

Whenever we're doing a procedure, prolonged procedure like surgery, then, I would use this as this thermometer because it's a constant readout. Just put this into the, the eye system, the rectum, and it gives you constant readout the whole time so you can make sure that the animal doesn't become hypothermic or hypothermic there are any prolonged any, any surgical procedure. Or even if you're just gonna take radiographs in there, it's sedated.

So let's just look at a few cases. This is a lateral radiograph of a rabbit. This has GI stasis, and it was secondary to these issues.

So there are calculi, ureteral and renal calculi. You can also notice, here's the stomach. You see how enlarged that is you get to the diaphragm to the heart and so on.

So. This is very, very distended. Over here you have gas.

This is in the GI system and and see and large intestines. Compare that and contrast this, this case, so this is different. He's a survey radiographs of rabbits with acute GI obstruction.

And the severely distended stomach here. And is filled with gas, not much gas here, OK, because there's obstruction here. So the gas can't leave.

And so you have fluid filled gas in the stomach, and again with the lack of GI. Gas and intestines. This is compatible with acute.

Proximal intestinal obstruction. Here, here's the stomach of gas. Here's the GI, not much gas in it.

This is a different case, but it was very similar. This is actually a necropsy of a of a 4 year old rabbit, it died from acute gastric rupture. There was obstruction.

It was caused by a hair pellet, and here it is. And this will be the stomach in here and you can see how hyperemic it is. So this did pass the stomach then it got into an area just distal to the pylorus and it caused obstruction.

You can see it's been there a long time based on this hyperemia or or inflammation in blood to the GI. So, This was very, very unfortunate because the stomach did in fact rupture. Because of this obstruction.

This is a a 9 month old rabbit that was brought to us. This is kind of another sad case. The rabbit was kept out of school.

It wasn't checked in 5 days because it was a holiday. It was on a poor diet. When they got back, he was anorexic because they had very little food left, no water.

He was depressed, he was shocking, and when he palpated the stomach, it was very, very painful. So the prognosis was so poor, that the school that took care of it, requested euthanasia. So this is just an enlargement of this, so what we're looking at is a distended grossly distended stomach, OK, and then, this is the colon.

So what was the, the issue that we that we had here? We had this demarcation area, this is the side of the duodenal obstruction, which is near the near the stomach actually. And this is the pellet that was in, so this is a hair mat that resulted in obstruction.

So the next thing you want to know is, well, how do we treat this? You really want to prevent it, but how do we treat it? They have.

So again, most rabbits, very high percent will respond to aggressive medical management, especially if they can get it to you soon enough. And that involves rehydration, very, very important because they are dehydrated. The mat in the stomach is dehydrated.

And this is done by combination. It's usually a combination of oral and scu. If it's really pretty acute or severe, then you can have an IV catheter with IV fluids going in as well.

We said the maintenance fluid is high, 100 to 120 or more millilitres per gig per day. And so we usually we administer administer about, you know, half 50 to 60 millilitres per cake per day subcutaneously, and then we give others, you know, or. Warm fluids.

Or electro electrolytes are, are generally required as well. And it's very important to to rehydrate the gastric contents, and that's the reason you are giving the the oral fluid, really with food as well. And the balanced electrolyte solutions.

Here we have Pedialyte. I'm not sure what it's sold where you're at, but this is, this is for, for children actually but be used by anyone, and it's electrolytes. So if someone is dehydrated in Pedialyte, but we also use this in in mammals as well.

And then force feeding. So force feeding, we usually try to give 10 to 15 millilitres per kg for as much as they'll comfortably take every 3 or 4 hours. Here we use critical care for herbivores by Oxfa, but, and I imagine you all have that available, but if not, you probably have some other critical care diets.

Just make sure that they're made for herbivores. Nothing made for a carnivore. If you have nothing, you can take rabbit pellets and you can blenderize them and put them in an electrolyte solutions such as Pedialyte.

Very seldom do we ever use a nasal gastric. And then I always, I used to have fresh greens, a lot of hay in there, I libido, and initially nothing is happening, but when you go in there one morning and all of a sudden you see some of the food gone, when you're turning the corner, that is a really a very good sign. And sometimes we'll get vitamin B complex.

It might, you know, stimulate appetite a bit, at least it certainly not be hurt. Well, these are the critical care diets that we use. Common views, there are others.

So, how does this come? Well, this comes as like a flake. OK.

And this is fine grind. This is if you're gonna use nasal gastric, but this is what we use in almost all cases. And you can use it for other herbivores as well.

We use it for guinea pigs and chinchillas. So this is how it comes. It comes as sort of a flake as a powder, and we add it to our container, and we add water to it, you mix it up.

Try to keep it somewhat warm. You know, stir it, and then you can go ahead and you can suck it up. Now, this is a larger syringe which we have used, but in general now we're using just like a one CC syringe.

And we'll hold the rabbit on our lap, often wrapped in a towel and make him comfortable, and we'll give them, you know, one mL at a time, and we'll just count how many we can give them. This works out very well. Sometimes when they use even a 12 cc, syringe as well, but once you see it works out well because that way they can.

You're not forcing it down, you give this a little bit of time and you just keep doing. So it works out really quite well. They may be a little hesitant at first to take it, but after a while they're more receptive once they're used to the system, and some of them, will even start taking it from a bowl because some of them actually do like it.

And there are other brands as well, that can be used, recovery Plus and And both, both these are made by sure order at least this one is. So these again are. Are available at some places as well.

So these are just other sources of critical care diets. So, what else can we do? Well, how about antibiotics?

Oftentimes, antibiotics aren't indicated, but there may be times that they actually might be, especially if it's later stages and you're trying to treat clostridial, but, but you think maybe clostridial overgrowth or or toxins may be produced, or if you think the animal is so compromised that you want to try to prevent any secondary infection. You can go ahead and give them in all prices. Now, we, we give that orally.

If you're gonna give it subcutaneously, that's fine, but you have to dilute it first, and you don't give it IM androfloxacin can cause necrosis and it's also very painful. So that's the reason it's indicated orally, subcutaneously and if it's diluted, you can, you can use it that way. Metronidazole will use more frequency again is effective against the the an you suspect you have an overgrowth.

And you can use these, you know, perennially initially until the stools are passed and then you can change it to to to oral. Analgesics, so the importance of analgesics cannot be overemphasised. You know, rabbits with GI pain and they just give up and die.

They just don't take pain at all. So what can you use? Well, meloxicam is commonly used.

You can use other NSAIDs as well. Meloxicam is, is the most common one that we use here. So it's, it's, you just have the most experience with it.

I've done 3 research studies on meloxicam and determined that the dosage is in fact 1 big per gig, except your I am a daily. Which is higher than some of the older references that say 0.2 to 0.3.

Buprenorphine, brophenol can be used as well. These are opiates and more severe cases of pain, so you can use those. It looks like there's no adverse effect on the GI function for, for short term use, but if for long term use it could start slowing down the GI which is don't want.

Some questions on tramadol, how effective that might be. And these are just some other drugs that have been used gabapentin, lidocaine depends on your experience and and you know, . Celtic cone.

So cymetic cone is a product at least in this country as an active for humans and the abdominal discomfort and it it absorbs gas. So if there's a lot of gas there that may be something you want want to consider. And how about a gastroility pro gastrointestinal promortility agent?

Well, metoclopramide, as long as you know we're pretty convinced, I guess no actually it's better, you don't have obstruction. Well, we would use metoclopramide because we do want the GI system to start moving. How about cisapride?

Well, cisapride is also a very good product. In the United States, it's not commercially available anymore it's a drug. But we can get it compounded.

Sometimes we don't get it compounded in time. But if you use the combination of these are just metoclopramide, that will, you know, promote gastric pain and, increase GI activity. Absorbent, I really have never used, but in the literature it says some people have tried it.

This is a human drug cholestyramine, and it has a resin that can absorb clostridial toxins. So I can't attest to it, but it is listed. And I've also really only once or twice every use of cytidine, but some people think they may want to add it to their little arsenal for treatment if they think that maybe there's some evidence of gastric ulceration, and I'm not exactly sure how, how you know you have that evidence.

So again, I don't think it's. If they're needed, but it may not hurt. Occasionally if a rabbit is, is not doing well, but it's really anxious, sometimes a low dose of midazolam that might relax them a bit, take away some of the anxiety and, can, can stimulate, .

Appetite a bit. Probiotics become are becoming more popular. They may not help.

You don't hurt. Exercise and abdominal massage is important, especially well in the hospital, we, we, we always do that, but also if the animal goes home. And still has some signs, try to keep them moving and abdominal massage and stimulates the GI.

If the body temperature is below 99, then you wanna make sure there's some kind of thermal support. And keep them in a quiet environment. So we, we, we, we, we do hospitalise and then grooming owners can do that, but you wanna do in your practise.

These guys aren't doing well, they're in a stressful environment in the hospital, and they'll just keep trying to chew their hair so you wanna keep grooming that and so they don't make it any worse. And of course correct the cause, you can determine what the cause is. So, rabbits generally recover more quickly when and if they can be treated at home.

So that's important, but, we recommend you don't send them home unless they are improving throughout the treatment period. Because you want to monitor the animals carefully, so monitor appetite and defecation. We can also in the hospital, we can do ausculation, we can weigh them more, we can do the abdominal palpation, we can do imaging, CBC and chemistries, and check hydration.

So there's a lot we can do that clients can do. But once you think they're on the demand and are doing fairly well, then it would be a good time to send them home with the oral, you know, oral meds and oral feeding stuff. Gastric outflow obstruction can can occur.

This is acute, and it presents as an acute abdomen for mechanical obstruction. When they come in, they'll have reduced body temperature, they'll be very painful. Diagnosis is a clinical signs.

Physical exam. Radiography will be an important clue or or ultrasound and treatment. Depends, it depends how serious it is, but if it's really totally, constructive and One thing you may want to do initially is try to decompress, and that's where you can anaesthetize the rabbit, put in a 14 to 16 French red rubber tube has different additional holes at the end, and you can try to suck out some of the materials, some of the gas and stuff.

You can also administer fluids and analgesics post decompression. And then at that point, maybe they'll start doing better, may not be, but then they'll be at least a better candidate for surgery if you're gonna do it. And apparently some patients.

Have been reported to actually recover without surgery once they don't have that, that pain anymore and and you're hydrating them, that may give them a help, help the intestines a bit, so whatever obstruction might be there might, might be able to pass. And then a gastronomy is if it's unresponsive to any medical therapy or decompression. Intestinal surgery, you know, can be indicated for obstruction again maybe after decompression, and if there's no response to aggressive medical therapy.

Survival post GI surgery though is, is not, is not high. It is not as good, . As it is in dogs and cats.

The procedure is very similar to that. The surgical procedure is that in the dog and cat. So here's a, here's a surgery, here's the extended stomach and this is the trichal resources that.

So prevention, and I'm almost through, you wanna make sure that you feed a high fibre, high quality diet because it stimulates digestion. And peristalsis decrease stress, how the owner avoid obesity in the rabbit, avoid boredom, routine brushing by the client, and restrict access to blankets. This is a blanket that was, in the bedding of a rabbit that came in to say he just chewed it all up, which is certainly make him really prone to obstruction since this is not digested.

There are some sources of information out there. There's an exotic formulary. There's other formularies as well that have dosages and stuff, and for a small mammal book, this is one that's been proven, proven pretty useful.

There's rabbits and rodents, clinical medicine and surgery, and it was published, a few months ago. So hopefully, with good husbandry and nutrition, routine health exam, rabbit GI syndrome can be avoided, and this is a When you joint Those who are interested is an association in North America, I think it was national, international now, of course. Association of Exotic mammal Veterinarians, something that you guys may want to consider if you're not already a member.

Also, the ACC and the American College of Zoological Medicine has now exotics as a as a specialty. So again, thank you very much for attending. I hope you glean some information from it.

Sorry I'm not there with you in person, but again, I really appreciate your attention. Thank you very much.