GI Disorders in Exotic Companion Mammals: Focus

on Stasis, Obstruction, and Pain

Vladimír Jekl, DVM, PhD, DECZM (Small Mammal); Karel

Hauptman, DVM, PhD

Faculty of Veterinary Medicine, Avian and Exotic Animal Clinic,

University of Veterinary and Pharmaceutical Sciences, Brno, Czech

Republic

Tokyo Vets
The most common disorders of gastrointestinal tract in herbivorous exotic companion mammals is ileus. Ileus
is defined as disruption of the normal propulsive gastrointestinal (GI) motor activity from non-mechanical
mechanisms (synonyms: paralytic ileus, functional ileus, gastrointestinal stasis) or because of bowel
obstruction (synonyms: mechanical ileus, mechanical obstructions). The cause of the obstruction may be
external to the bowel (extrinsic), within the wall of the bowel (intrinsic), or due to a luminal defect/foreign
body that prevents the passage of gastrointestinal contents. Obstruction of the intestine can be partial or
complete. The most common cause of the bowel obstruction in exotic companion mammals is a presence of
intraluminal foreign body.

In rabbits, the term gastrointestinal syndrome or rabbit gastrointestinal syndrome was recently used to
define a complex of clinical signs, symptoms, and concurrent pathologic conditions affecting the digestive
apparatus of the rabbit. The following pathologic conditions can be included, and often occur in combination:
gastric impaction, gastric gas accumulation, intestinal impaction, intestinal gas accumulation, intestinal
obstruction, primary gastroenteritis, adhesions, neoplasia, pancreatitis and liver disease. It is true that the
pathophysiology of the primary GI stasis etiology and secondary diseases is in exotic companion mammals
very wide and they are even more complex than already described.

NON-MECHANICAL OBSTRUCTION (STASIS)

The GI motility decrease, the digesta retention is prolonged and the normal balanced ecosystem in bowel
(especially cecum) is disrupted. Cecal pH is altered and allow potentially pathogenic bacteria to overgrowth
(Clostridium sp., E. coli). This bacterial overload could lead to clinical enteritis/typhlitis or to enterotoxaemia.

In case of prolonged digesta retention in stomach, there is a risk of gastric ulcers development, which leads
to another source of pain.

Gastrointestinal hypomotility results in gas formation in intestines (mostly caecum) or stomach. Gas
distension is painful and stimulates the sympathetic nervous system and deteriorate the situation.

Secondary impaction can be produced by over accumulation of normal gastrointestinal contents due to
alterations in motility, or desiccation of normal contents due to dehydration.

Tokyo Vets
Metabolic acidosis is common sequela of negative energetic balance due to anorexia esp. in rabbits and
herbivorous rodents.

MECHANICAL OBSTRUCTION

Primary mechanical obstruction of the stomach is commonly seen by the author in ferrets. Various foreign
bodies of different origin (mostly rubber, foam, earplugs) are located within the stomach of the ferret. Foreign
bodies are causing permanent or temporary pyloric obstruction or can be passed distally into the duodenum or
jejunoileum, where can cause permanent obstruction.

In rabbits, the most common site of the GI obstruction seen at the authors practice is in the proximal
duodenum. In case of distal GI is the obstruction located in the distal part of the cecum or proximal colon.
However, this obstruction is commonly secondary due to caecal content dehydration and cecolite formation
(seen in rabbits and chinchillas. In guinea pigs, signs associated with GI obstruction are present in case of
gastric dilatation/torsion. It was stated that the pellets of impacted hair that acutely obstruct the small intestine
of rabbits are a completely different condition from the hairballs (gastric trichobezoars) or impacted stomach
contents that develop during periods of gastric hypomotility. It seems, that the pellets are formed by
compression of ingested hair during passage through the large intestine, and the excreted pellets containing
the compressed hair are accidentally re-ingested during cecotrophy. This would explain why the pellets are
similar in size to hard feces and are so compressed. Small hair pellets can pass through the digestive tract
whereas larger pellets may obstruct the intestine causing pain, which slows gut motility and further reduces
the chance of the pellet moving along the intestinal tract. In some cases, the obstruction does move through
the small intestine, resulting in a spontaneous recovery as it passes into the hindgut.

Obstruction leads to progressive dilation of the GI tract proximal to the blockage. Swallowed air, and gas
from bacterial fermentation, can accumulate, adding to stomach or intestine distention. As the process
continues, the stomach/intestine wall becomes edematous, normal absorptive function is lost, and fluid is
sequestered into the bowel lumen. In severe cases, the perfusion to the GI wall is reduced and obstructions
leads to ischemia, which will eventually lead to necrosis and perforation. In ferrets, with pyloric or duodenal
obstruction, ongoing emesis leads to additional loss of fluid containing sodium, potassium, chlorides,
hydrogen ions and to metabolic alkalosis. In rabbits and rodents which cannot vomit, the gas and fluid
accumulation leads quickly to stomach dilatation and cardiovascular collapse. In rabbits and guinea pigs,
stomach dilation readily leads to metabolic acidosis. These fluid losses (vomiting or into the GI tract) can
result in hypovolemia. Bacterial overgrowth can also occur in the proximal duodenum, which is normally
nearly sterile. Gastric mucosa erosions and/or ulcerations can develop due to reduced vascular supply of the
stomach.

Tokyo Vets
PAIN MANAGEMENT AND GOALS OF THE THERAPY

Recognizing the pain (inactivity, anorexia, staring, reduced comfort behavior, pressing of the belly against
the ground, changes of the facial mimic, other behaviour changes).

Try to find out the primary (or secondary) etiology.

Anxiolytics, first line analgesia/sedation:

Midazolam (0.2–0.5 mg/kg IM) + ketamine (rabbits, rodents 5 mg/kg IM)

Opioids:

Butorfanol: 0.2–0.5 mg/kg IM

Buprenorphine: 0.01–0.05 mg/kg SC

Fentanyl/fluanisone: 0.2–0.3 mg/kg SC

Thermal support

IV access and IV fluids:

No saphenous or femoral veins

e.g., lactated Ringer's

Diagnostics:

Abdominal radiography

Abdominal ultrasound (more helpful in ferrets)

Tokyo Vets
Hematology

Blood chemistry:

Pain is in rabbits associated with marked hyperglycemia (above 350 mg/dl).

Urinalysis (esp. pH)

Blood acid-base balance

Treat the primary disease/diseases

Pain medication:

NSAIDs (can be controversial):

Meloxicam: 0.1–0.3 mg/kg SC q12h (use with care in ferrets)

Opioids:
 Buprenorphine: 0.01–0.05 mg/kg SC q8–12h

Or CRI: Fentanyl 5–10 mg/kg/min, ketamine 1–2 mcg/kg/h

Hydromorphone: 0.1 mg/kg SC, IV

(Tramadol: 10 mg/kg PO q8–12h)

Prevention of gastric ulceration:

Ranitidine: 5 mg/kg IM q12h

Famotidine: 1–3 mg/kg PO q12–24h

Prokinetics (only in case of nonobstructive ileus or postoperatively):

Tokyo Vets
Metoclopramide: 0.5–1 mg/kg IM q8h

Ranitidine: 5 mg/kg IM q12h

Itopride: 10 mg/kg PO q12h

Trimebutine: 1–2 mg/kg PO q12h

(CRI lidokain: 0.01 mg/kg/min IV)

Simethicone: 65–130 mg PO q3–12h

Feeding (only in case of non-obstructive ileus or postoperatively):

Recovery diet (force-feeding - syringe, nasogastric tube)

Herbivores: Fresh grass, vegetables and fruits

Surgery:
 Gastroscopy in ferrets

Gastrotomy/enterotomy

Authors are, in general meaning, not afraid of so called "problematic rabbit gastrointestinal
surgeries." The main issue is how much and how long is mechanical obstruction present, if
intestine wall is necrotic, if cardiovascular changes developed, if there is a presence of gastric
ulcers, hepatic lipidosis and/or metabolic acidosis and if the animal suffering from any other
concurrent disease.

Foreign body "milking" distally

Stress release/anxiolysis:

Quite hospitalization

Benzodiazepines (see above)

Tokyo Vets
(Pheromones)

Antibiotics:

When indicated (not used by the author routinely)

Notice: Optimal management of GI stasis need to be determined based on particular clinical case. Dosages
and therapeutic protocols used in this paper are recommended and used in the author's practice, however need
to be adjusted when indicated or not used at all.

References

1. ACLAM Task Force Members, Kohn DF, Martin TE, et al. Public statement: guidelines for the
assessment and management of pain in rodents and rabbits. Journal of the American Association for
Laboratory Animal Science. 2007;46(2):97–108.
 2. Allweiler SI. How to improve anesthesia and analgesia in small mammals. Veterinary Clinics of North
America: Exotic Animal Practice. 2016:19:361–377.

3. Harcourt-Brown TR. Management of acute gastric dilation in rabbits. Journal of Exotic Pet Medicine.
2007;16(3):168–174.

4. Huynh M, Boyeaux A, Pignon C. Assessment and care of the critically ill rabbit. Veterinary Clinics of
North America: Exotic Animal Practice. 2016;19:379–409.

5. Lichtenberger M, Lennox AM. Updates and advanced therapies in gastrointestinal stasis in rabbits.
Veterinary Clinics of North America: Exotic Animal Practice. 2010;13(3):525–541.

6. van Oostrom H, Schoemaker NJ, Uilenreef JJ. Pain management in ferrets. Veterinary Clinics of North
America: Exotic Animal Practice. 2011;14:105–116.

Vladimir Jekl, DVM, PhD, DECZM (Small Mammal)

Tokyo Vets
Faculty of Veterinary Medicine
University of Veterinary and Pharmaceutical Sciences
Brno, Czech Republic