Anorexia in small mammals Flashcards
(83 cards)
1
Q
History Q’s
A
- diet?
- faeces - quantity? appearance?
- any recent changes?
- inside/outside?
- stress? pain?
- any new pets?
2
Q
What can incorrect diet cause?
A
- bloat
- diarrhoea (common if fed sugary diet)
- dysbiosis
- GI bacterial infections (usually from eating spoilt food or scavenging (ferrets))
- hepatic lipidosis (common in obese animals)
- obesity which prevent caecotroph ingestion
3
Q
Common conditions for indoor and outdoor pets
A
- outdoor: exposure to wildlife e.g. virus and endoparasites
- indoor: if loose higher chance of FB and trauma
4
Q
Why can stress cause gut problems in hindgut fermenters?
A
- it causes hypo motility which can then lead to anorexia and other problems e.g. gut stasis, gastric ulcers and bloat
5
Q
Causes of stress in rabbits
A
- predators
- new rabbits
- sudden change of diet
- change of housing
- transport
- extremes of weather/temperature
- loss of a companion
6
Q
Main differences to CE cf a dog
A
- auscultate the GIT in hindgut fermenters
- need to use an otoscope for visualisation of cheek teeth
- need to check ear canals and joints (any source of pain/dz can trigger gut stasis/GI issues, hence need to check everywhere)
7
Q
Hindgut fermenters - examples
A
- rabbits
- guinea pigs
- degus
- chinchillas
8
Q
Ferret CE cf cat
A
- different handling techniques: scruffing often used as lots of extra skin in the area, therefore shouldn’t be painful or stressful
- splenomegaly is common and often an incidental finding
9
Q
Clinical examination
A
- always examine teeth during CE and whenever under GA for anything else
- observe and palpate whole head thoroughly
- retract lips to examine incisors (in rabbits & GPs)
- in species with radicular hyposdont pre–molars and molars, always use an otoscope to examine molars, tongue, cheeks
- don’t forget to check eyes (nasolacrimal ducts pass tooth roots)
- abdo palpation, BCS, checking perineal area all very important
- can advise further exam under sedation
10
Q
Reduced wear in teeth in hindgut fermenters is due to
A
- not enough fibre (veg/hay)
- selective eating
11
Q
Weaker teeth in hindgut fermenters is due to
A
- sugary treats and fruit
- vitamin C deficiency (GP)
- selenium deficiency
- Ca/P imbalance (MBD)
12
Q
Problem with sugary treats and fruit in hindgut fermenters
A
- decay and caries can develop
- predisposes to dental abscesses, and deficiencies
13
Q
What is a tooth overgrowth in rabbits known as?
A
- a spur
14
Q
In rabbits which way do the upper and lower cheek teeth grow towards?
A
- upper: into the cheek
- lower: into the tongue
15
Q
Guinea pig cheek teeth
A
- same as rabbits
- but their lower cheek teeth curve slightly inwards (this is normal)
- when they overgrow they form an arch and can trap the tongue
16
Q
Ideal rabbit diet
A
- 85% hay (not alfalfa)
- 10% veg
- 5% pellets (not muesli)
17
Q
Breeding and dental dz
A
- inherited predisposition
- malocclusion
- brachycephalic conformation
18
Q
Signs of GI dz
A
- anorexia
- reduced/no faecal output
- small dry faecal droppings
- diarrhoea
- hunched up / lethargic
- faecal staining (+/- myiasis)
- dribbling/wet front paws
- caecotrophs accumulation (rabbits)
- anal impactions (GPs)
19
Q
Diagnostic tests
A
- oral exam and abdo palpation under sedation
- haematology & biochem
- urinalysis
- faecal flotation & wet smear
- radiography +/- barium
- US
- endoscopy
20
Q
Haematology & biochem
A
- often non-specific
- stress leukogram is a common finding
21
Q
Hyperglycaemia causes
A
- stress
- pain
- advanced liver dz
22
Q
Hypoglycaemia causes
A
- starvation/anorexia
23
Q
What do elevated TP & HCT +/- urea/creatinine indicate?
A
- dehydration
24
Q
Reduced albumin causes
A
- production
- loss
- ingestion
25
Liver parameters
- TBIL
- ALT
- AST
- GGT
- ALKP
26
Common GIT conditions in hindgut fermenters
- dental disease (primary or secondary)
- gut stasis (motility decreases and gas builds up in the intestines)
- bloat (gas accumulation in the stomach)
- gastric ulceration (stress and slowing of the GIT can predispose to them)
- impaction or FB
- neoplasia (e.g. lymphoma, adenocarcinoma)
- bacterial (dysbiosis and enteritis)
- viral (e.g. coronavirus, rotavirus, rabbit hemorrhagic dz (RHD))
- parasitic (e.g. pinworm, eimeria)
- liver lobe torsion (rabbits)
- GDV (GP)
27
Why can rabbits get liver lobe torsion?
- 1 lobe is quite loose and mobile
- check for this if present with acute sudden pain
28
Gut stasis
- slowing/stopping of the passage of food through the GIT
- typically affects the hindgut of hindgut fermenters
- clinical sign not diagnosis, but needs to be specifically treated
29
Causes of gut stasis
- pain
- stress
- incorrect diet
- lack of caecotrophy
- GI bacterial infection, viral , parasites
30
2 types of causes of gastric bloat
1. physiological obstruction e.g. gastric stasis due to pain or diet
2. physical obstruction e.g. FB, neoplasia, GDV
- aggressive stabilisation required in all cases
- surgery may be required if a physical obstruction
31
Onset of gastric bloat
- quite acute
- in a lot of pain
32
Normal commensals of hindugt fermenters
- Bacteroides
- Enterococcus
- Staphylococcus
- E.coli
33
Dysbiosis
- microbial imbalance
- usually an overgrowth of clostridia and/or coliform secondary to diet change, stress or oral antibiotics
34
What do Bacteroides appear to inhibit?
- pathogenic bacterial growth
35
Is Lactobacillus present or absent in rabbits?
- absent
- therefore, use rabbit specific probiotics that do not contain Lactobacillus
36
Enteritis (bacterial) clinical signs in hindgut fermenters
- anorexia
- diarrhoea
- haematochezia
- dehydration
- shock
- death
37
Bacterial enteritis
- Clostridia spp overgrowth
- E.coli overgrowth in juvenile rabbits under stress
- Salmonellosis
- Pseudomonas
- Yersinia psuedotuberculosis (acute and chronic forms)
- Lawsonia intracellularis
38
Dysautonomia
= idiopathic malfunction of the autonomic nervous system
39
Clinical signs of dysautonomia
- GI stasis
- dry mm and conjunctiva
- mydriasis
- bradycardia
- urine retention
- megaoesophagus
- mucoid enteritis
- LI impaction (as often very dehydrated)
- may be found dead with food impacted in mouth
40
Caecal impaction
- occasionally occurs in adult rabbits
- aetiology is often unclear, may be secondary to stress or ingestion of substances e.g. cat litter
- prostaglandins have been used to try and empty the caecum but generally few respond and prognosis is poor
41
Anal impaction
- common in older male GPs
- gentle manual expression
42
Clinical signs of Eimeria steidae
- weight loss
- ascites
- jaundice
- causes GI and liver dz
43
Common GIT conditions of ferrets
- inflammatory bowel disease
- endoparasites (e.g. ascarids)
- protozoa (e.g. eimeria, giardia)
- viral (e.g. ferret enteric coronavirus, rotavirus, canine distemper)
- bacterial (e.g. Helicobacter mustelae, Lawsonia intracellularis, Salmonella, Campylobacter and E.coli)
- obstruction (e.g. intestinal, anal glands)
44
Is Giardia zoonotic?
- yes
45
What is ferret enteric coronavirus emergent from?
- FIP
46
Ferret rotavirus
- can make them very poorly
- D+++ and GI dz
47
Helicobacter mustelae in ferrets
- affects the GIT, but particularly the stomach which is uncommon for bacterial infections
- needs specific and intense tx
- a lot of ferrets are carriers
- majority of ferrets don't have clinical dz
- may increase risk of gastric neoplasia, gastric ulceration and possibly liver dz
- can cause megaoesophagus
- debate about relevance if find it and what to do
48
Neoplasia in ferrets
- lymphoma and adenocarcinoma are common
- possibly secondary to helicobacter mustelae
- often find enlarged LN on ex-lap (histology required)
49
Common GIT conditions in rodents
- enteritis
- antibiotic associated enterotoxaemia
- cheek pouch impactions and infections
- overgrown incisors e.g. malocclusion, trauma
50
Enteritis in rodents
- rodents aren't hindgut fermenters, therefore bacterial causes are most likely to cause enteritis
- bacterial e.g. salmonella, Clostridium piliforme (Tyzzer's disease), Lawsonia intracellularis (wet tail - common in hamsters)
- viral
- parasitis e.g. oxyurids, cestodes
- dietary change
51
Dental clinical exam
- look at incisors by parting the lips
- look at cheek teeth by using an otoscope, view is limited when conscious
- look at a minimum of 4 points in the mouth with an otoscope when they're conscious
52
Why do dental imaging?
- 2/3rd of teeth are sub-gingival
- acquired dental dz is progressive and teeth/bone are often abnormal and used to stage dental dz
- radiographs are helpful but CT is best
53
Frances Harcourt-Brown staging for acquired dental dz
Stage 1 = normal
Stage 2 = root elongation & deterioration
Stage 3 = acquired malocclusion
Stage 4 = cessation of tooth growth
Stage 5(a) = end stage with osteomyelitis and abscess formation
Stage 5(b) = end stage with calcification of teeth and alveolar bone
54
Views for dental radiography
- lateral: open mouth, closed mouth
- latero-oblique
- dorsoventral
55
Underlying principles for tx for all spp
- restore circulatory volume (fluid therapy)
- analgesia
- restore GI motility (pro kinetics)
- restore GI hydration (syringe feed q4h)
- prevent ulceration and hepatic lipidosis
- eliminate stress (correct husbandry/handling)
- identify and tx underling dz
56
57
Prokinetics (including doses) for rabbits
- Cisapride (acts on upper and lower GI): 0.1-1mg/kg q8-12h
- Metoclopramide (upper GI only) 0.5-1mg/kg q6-12h
- Ranitidine (mostly upper GI) 4-6mg/kg q8-12h
- only give if no obstruction
- gut stasis generally affects the lower GIT
- metoclopriamide alone is not good enough tx for gut stasis, but good for slow stomach emptying or crop stasis in birds
- metoclopramide and ranitidine work synergistically so good together
58
Antacids for rabbits
- Ranitidine
- Omeprazole
59
Fluid therapy (including doses) for rabbits
- SC fluids: 10ml/kg, max 20 ml per site, isotonic saline, warmed
- IV (or IO): shock rate - 100ml/kg (divide into 15m boluses), maintenance - 4ml/kg/hr (can also divide into boluses)
- too much sc fluid in 1 site can be painful
- need to warm as smaller pts are more likely to get hypothermic if giving cold fluids
- nibblers so drip lines not always a great choice
- if pt bright and generally well consider giving days fluids in regular small slow boluses
60
Safe antibiotics in hindgut fermenters
- Medications For Treating Small Mammals
- metronidazole
- fluoroquinolones (except pradofloxacin)
- tetracyclines
- sulfonamides
- macrolides (except erythromycin)
61
Possibly dangerous antibiotics for hindgut fermenters
- PLACE
- penicillin
- lincosamides (e.g. clindamycin)
- aminoglycosides (possibly)
- cephalosporins
- erythromycin
62
Other tx
- anthelmintics: fenbendazole
- coccidiostats/cides: TMPS, toltrazuril
- simethicone for gastric bloat? seems to help gastric bloat but not gut stasis
- lactulose? if worried about hepatic lipidosis - is a liver protectant
- probiotics?
63
Kennelling
- keep away from busy areas as well as away from the sight, sound and smell of predators
- hospitalise with cage mate
- encourage owners to bring normal food and utensils
- ensure soft, dry bedding and plenty of fresh hay
- provide hide box
- gentle handling and restraint
64
Nursing care
- hand and syringe feeding
- cleaning soiling and discharges
- note faecal output (type, consistency, size)
- gentle abdominal massage
- allow to exercise daily if condition allows (can allow gas movement out if their intestines in gut stasis)
65
Nutritional support
- hindgut fermenters need to eat regularly
- when fasted their gut motility slows/stops and this can be fatal
- never starve rabbits, even before GA
- success of assisted feeding plans are dependent on the frequency of feedings, and what is being fed
- oral feeds: 10-20ml/kg per feed, 6 feeds per day (q4h)
- critical care foods e.g. EmerAid, Oxbow
- ground up, watered down pellets
66
Gastric bloat tx
- critical pts -> IVFT necessary
- analgesia & sedation
- decompress with orogastric tube (slowly as easy to rupture)
- can give liquid barium via a tube and take lateral radiograph
- start drug therapies
- if recurs or barium doesn't pass into intestines = surgery
67
Dysbiois/enterotoxaemia tx
- fluid therapy
- stop any offending antibiotics
- cholestryramine
- probiotics?
- transfaunation of caecotrophs?
- start required drug therapies
- antibiotics? metronidazole + enrofloxacin can be used (protected but these animals are close to dying therefore use justified)
68
Accumulated caecotrophs tx
- clip and clean perineum (often need sedation)
- start required drug therapies
- treat underlying causes e.g. husbandry, obesity, perineal folds, arthritis, dental disease, etc
- exclude treats, fruit and root vegetables from diet
- provide ad-lib hay and grass
- for stubborn/repeat cases can think about putting them on a hay only diet
69
70
Dentistry
- deep sedation/GA mandatory for cheek teeth tx
- good lighting
- aim is to restore normal, pain-free occlusion as much as possible
- don't lower crowns too far esp if molars stopped growing
- warm owners of need for multiple tx (and repeating extractions if they snap, e.g. 4-6w later)
71
Elodonts
- rabbits & hystrcomorph rodents e.g. GPs, chinchillas, degus
- continuously growing cheek teeth
- large occlusal surface for grinding
- tend to be herbivores
72
Anelodonts
- rats, mice, gerbils, hamsters
- short crowned, rooted cheek teeth - don't grow
- grain eaters or omnivores
73
Cheek teeth dentistry equipment
- stand -> positions body and opens mouth
- mouth gag -> opens mouth if not using a stand
- cheek dilators -> widens the mouth
- diamond burrs -> to attach to the low speed hand piece of a dental machine with a straight nose cone
- hand rasps not recommended
74
Cheek tooth crown reduction
- manual hand rasps generally not advised as may cause loosening of teeth, soft tissue trauma and haemorrhage (inferior alveolar vessels)
- motorised burrs on a straight slow speed handpick is preferred
75
Cheek tooth extraction equipment
- specialist locating elevator available (Crossley elevator)
- can use a bent 18g needle to break down attachment if don't have a suitable elevator
- can refer if a complex case e.g. CT scan cf radiographs
76
Cheek tooth extraction
- use rabbit molar Crossley elevator or bent 18G needle
- difficult unless already significant loosening
- break down ligaments until the tooth is very loose then use extraction forceps to gently remove (to prevent the tooth from snapping)
- if it snaps, wait 4-6w for it to re-grow then try again
77
Incisor dentistry equipment
- slow speed hand piece attachment
- fast speed hand piece attachment
- always place a syringe behind the incisors to protect the soft tissue with both methods
78
Why should you never cut incisors with tooth cutters?
- micro-fractures occur every time you cut an incisor with these
- eventually this can fracture the tooth in half
79
Incisor extraction
- use rabbit incisor Crossley elevator or bent 18G needle
- be patient and gentle and work on all 4 sides of the tooth equally
- ensure the germinal epithelium is removed or destroyed
80
Do you need to remove the opposing tooth as wells the one that is diseased?
- incisor: yes as there's less teeth/occlusal surface
- molar: maybe not due to grinding motion, but if remove 2 next to each other potentially as may not grind down
81
Dental nerve blocks
- infraorbital nerve
- mental nervve
- deep mandibular nerve
82
Dental abscesses
- rabbits and GPs have thick pus so abscesses need surgical excision
- tx involves surgical removal/shelling out abscess and its lining/capsule
- the wound is then kept open by suturing the edges of the incision to the skin (marsupialisation)
- find and address underlying cause of the abscess e.g. removing the tooth roots involved
- imaging is a necessity (radiographs or CT)
- abscess surgery and tooth removal can be performed in 1st op practice
- a swab of the abscess pus and a section of the abscess lining sent for C&ST
- whilst waiting for results never use enrofloxacin (not 1st line, and rarely found to be effective for abscesses in rabbits)
- TMPS or injectable penicillin effective, if using 1 of these 2 also want to use metronidazole for anaerobic coverage
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