Rabbit Gastrointestinal motility disorders

Question 1

A 4-year-old neutered male lop rabbit is presented for sudden anorexia and absence of feces for 12 hours. The rabbit is alert but tachypneic. Rectal temperature is 36.9°C. Abdominal palpation reveals a large, fluid-filled stomach and mild discomfort. Intestinal sounds are increased.

What is the most likely diagnosis?
A. Gastrointestinal stasis
B. Proximal gastrointestinal obstruction
C. Infectious colitis

Answer 1

B. Proximal gastrointestinal obstruction ✅

Question 2

A 6-year-old spayed female rabbit is presented for acute depression and watery brown diarrhea. She is hypothermic (36.4°C), anorexic, and mildly bloated. She shares housing with recently weaned kits. You suspect enterotoxemia.

Which pathogen is most likely responsible?
A. Clostridium spiroforme
B. Escherichia coli
C. Lawsonia intracellularis

Answer 2

A. Clostridium spiroforme ✅

Question 3

A 3-year-old indoor dwarf rabbit presents for intermittent soft, malodorous feces. The diet consists mostly of commercial muesli mix and minimal hay. The rabbit appears otherwise healthy.

What is the most likely underlying cause?
A. Cecal impaction
B. Cecotroph dysbiosis due to inappropriate diet
C. Dental abscessation

Answer 3

B. Cecotroph dysbiosis due to inappropriate diet ✅

Question 4

A 5-year-old rabbit is presented with a history of straining during defecation and occasional mucus in feces. Abdominal palpation reveals firm masses in the caudal abdomen. Radiographs show dense, rounded material in the cecum.

What is the most likely diagnosis?
A. Cecolithiasis
B. Urolithiasis
C. Cecal torsion

Answer 4

A. Cecolithiasis ✅

Question 5

A 10-week-old intact rabbit, purchased from a pet store 3 days ago, is presented for watery diarrhea, dehydration, and bruxism. The owner mentions the rabbit has been housed on newspaper and eats mostly pellets. Fecal PCR confirms Lawsonia intracellularis.

Which condition best describes this presentation?
A. Tyzzer’s disease
B. Proliferative enteropathy
C. Hepatic coccidiosis

Answer 5

B. Proliferative enteropathy ✅

Question 6

A 2-year-old rabbit presents with anorexia, grinding teeth, and absence of cecotrophs. Abdominal ultrasound reveals gas distension in the colon and a thickened cecal wall. Diet history reveals recent sudden change to alfalfa pellets.

Which of the following is the most likely cause of clinical signs?
A. Cecal dysbiosis
B. Encephalitozoonosis
C. Pancreatitis

Answer 6

A. Cecal dysbiosis ✅

Question 7

A 3-year-old outdoor female rabbit is found collapsed with profuse hemorrhagic diarrhea and hypothermia. She died before arrival. Her bonded companion is febrile (40.2°C) and shows signs of lethargy and respiratory distress.

What is the most likely cause?
A. Rabbit hemorrhagic disease virus type 2 (RHDV2)
B. Clostridium difficile
C. Coronavirus

Answer 7

A. Rabbit hemorrhagic disease virus type 2 (RHDV2) ✅

Question 8

An overweight 6-year-old house rabbit has strong body odor and fecal staining around the perineum. The owner describes soft fecal pellets left untouched in the cage. Oral exam and posture are normal.

What is the most likely explanation for the observed signs?
A. Neurologic incontinence
B. Inability to consume cecotrophs due to obesity
C. Dental pain inhibiting prehension

Answer 8

B. Inability to consume cecotrophs due to obesity ✅

Question 9

A 5-year-old rabbit has a history of repeated episodes of anorexia and decreased fecal output, often resolving with fluid therapy and assisted feeding. He is housed alone and eats primarily pellets. No dental disease is found.

Which change is most likely to improve long-term outcome?
A. Adding multivitamins to water
B. Switching to a hay-based, high-fiber diet
C. Daily prophylactic metoclopramide

Answer 9

B. Switching to a hay-based, high-fiber diet ✅

Question 10

A 1-year-old intact male rabbit is presented in lateral recumbency, hypothermic (35.5°C), and bradycardic (160 bpm). The abdomen is extremely distended and tympanic. Radiographs reveal a severely dilated stomach with fluid-gas line.

What is the immediate treatment priority?
A. Stabilization with IV fluids and decompression
B. Immediate exploratory laparotomy
C. Oral administration of simethicone and motility drugs

Answer 10

A. Stabilization with IV fluids and decompression ✅

Question 11

A 6-year-old neutered female rabbit presents with 3-day anorexia, absence of feces, and progressive abdominal distension. On exam: T = 36.1°C, HR = 180 bpm, RR = 60 bpm. Abdominal palpation reveals a doughy, non-painful mass in the mid-abdomen. Ultrasound confirms markedly distended cecum with thick content and hypomotility. Blood work shows azotemia and mild hyperkalemia.

What is the most appropriate initial stabilization strategy?
A. Subcutaneous fluids, syringe feeding, and enrofloxacin
B. Intravenous fluids, decompression if needed, and analgesia with buprenorphine
C. Laparotomy and cecotomy for content removal

Answer 11

B. Intravenous fluids, decompression if needed, and analgesia with buprenorphine ✅

Question 12

A 3-year-old house rabbit presents for chronic cecotroph accumulation under the tail. Physical exam reveals dental spurs and mild mandibular swelling. Radiographs confirm bilateral molar elongation and root intrusion.

What is the most appropriate explanation for the fecal signs?
A. Behavioral avoidance due to territorial stress
B. Inability to ingest cecotrophs due to oral pain C. Cecal parasitism by Eimeria spp.

Answer 12

✅B. Inability to ingest cecotrophs due to oral pain

Question 13

A 2-year-old intact doe presents 36 hours postpartum with anorexia and minimal fecal output. Physical exam reveals hypothermia (36.2°C), weak femoral pulses, and bruxism. Palpation indicates a firm mass in the cecal region. The owner reports nesting behavior and refusal to feed the kits.

What is the most likely multifactorial cause of GI stasis in this case?
A. Ketosis, stress-induced dysmotility, and hypocalcemia
B. Parasitic enteritis, dehydration, and trauma
C. Endotoxemia, heat stroke, and uterine rupture

Answer 13

A. Ketosis, stress-induced dysmotility, and hypocalcemia ✅

Question 14

A 1-year-old male rabbit is presented for severe lethargy, minimal fecal production, and mild head tilt. On abdominal ultrasound, there is gas-filled cecum with reduced motility. Neurologic exam reveals delayed hopping and mild proprioceptive deficits. Bloodwork is normal.

Which condition could explain both GI and neurologic signs?
A. GI lymphoma with paraneoplastic encephalitis
B. Encephalitozoon cuniculi causing cecal dysbiosis and neurologic signs
C. Polioencephalomalacia secondary to cecal torsion

Answer 14

B. Encephalitozoon cuniculi causing cecal dysbiosis and neurologic signs ✅

Question 15

A 4-year-old breeding doe presents for lethargy, anorexia, and hematochezia. Several does in the colony have shown reduced fecal output over the last week. No new introductions. Fecal smears show rare Gram-positive rods and no parasites.

What is the most likely cause of the outbreak?
A. Lawsonia intracellularis outbreak
B. Clostridium perfringens enterotoxemia
C. Coronavirus enteritis

Answer 15

B. Clostridium perfringens enterotoxemia ✅

Question 16

A 5-year-old rabbit had GI stasis for 5 days, treated at home with simethicone, critical care, and no vet visit. He now presents collapsed, with severe abdominal pain and crepitus on palpation. Radiographs show pneumoperitoneum.

What is the most appropriate next step?
A. High-dose NSAIDs and oxygen therapy
B. Immediate exploratory laparotomy and cecal resection
C. CT scan to locate perforation before surgery

Answer 16

B. Immediate exploratory laparotomy and cecal resection ✅

Question 17

A 2-year-old rabbit has intermittent episodes of anorexia and soft stools that resolve spontaneously. Diet is consistent and includes high-fiber hay. Fecal cultures are negative. Colonoscopy (research context) reveals cecal mucosal hyperplasia.

What long-term management is most likely to help?
A. Probiotic supplement and frequent pellet feeding
B. NSAID therapy and regular dental burrs
C. Review of fiber particle size and possible food allergy elimination

Answer 17

C. Review of fiber particle size and possible food allergy elimination ✅

Question 18

A 3-year-old house rabbit is presented for “chronic diarrhea” per the owner. On exam, the rabbit is bright, hydrated, and defecating normal hard pellets. The perineum is stained with sticky fecal material.

What is the best explanation for these findings?
A. Chronic Giardia infection
B. Unconsumed cecotrophs due to environmental stress
C. Malabsorption syndrome

Answer 18

B. Unconsumed cecotrophs due to environmental stress ✅

Question 19

A rabbit presents with sudden collapse, cold extremities, tachypnea, and severe abdominal distension. The veterinarian suspects GI obstruction but is unsure whether it is gastric or cecal. Radiographs are equivocal.

What distinguishes cecal torsion from gastric dilatation in rabbits?
A. Cecal torsion typically has higher fever and reduced cecotroph production
B. Cecal torsion causes focal gas in the lower abdomen and sudden cardiovascular collapse
C. Gastric dilation never presents with abdominal pain

Answer 19

B. Cecal torsion causes focal gas in the lower abdomen and sudden cardiovascular collapse ✅

Question 20

A rabbit presents for a second episode of cecolithiasis within six months. Diet is hay-based, with occasional greens and pellets. The rabbit is not overweight. Water intake is normal. No dental disease.

Which factor is most likely contributing to recurrence?A. Inadequate dietary calcium
B. Chronic dehydration due to insufficient fiber fermentation
C. Presence of Giardia spp.

Answer 20

B. Chronic dehydration due to insufficient fiber fermentation ✅

Question 21

A 3-year-old spayed female rabbit is presented on emergency with sudden-onset lethargy, no fecal output for 18 hours, and refusal to eat. On physical exam, she is hypothermic (36.3°C), has pale mucous membranes, tachypnea (110 bpm), tachycardia (270 bpm), and a markedly tympanic stomach on palpation.
Look at radiographs
Bloodwork shows:

Glucose: 27.1 mmol/L (489 mg/dL)
Sodium: 133 mmol/L
Osmolality: 316 mmol/kg
Which of the following is the most appropriate initial intervention?

A. Initiate syringe feeding with critical care formula
B. Proceed with orogastric decompression under sedation
C. Administer metoclopramide CRI and reassess in 6 hours

Answer 21

✅ Correct answer: B
➡️ Explanation: The patient exhibits all indicators of life-threatening intestinal obstruction (severe hyperglycemia, hyponatremia, radiographic gastric dilation beyond L2, and signs of shock), justifying immediate orogastric decompression to stabilize the rabbit before further management.

Question 22

A 5-year-old intact male rabbit presents with acute anorexia for 12 hours, normal hydration status, mild hypothermia (37.1°C), and slight abdominal discomfort. Radiographs show fluid gastric dilation not extending past L2.
Bloodwork reveals:

Glucose: 13.8 mmol/L (248 mg/dL)
Sodium: 140 mmol/L
Osmolality: 302 mmol/kg
Based on this presentation and the study findings, what is the most appropriate management approach?

A. Perform immediate orogastric decompression
B. Treat with supportive medical therapy and monitor closely
C. Recommend exploratory laparotomy for presumed foreign body

Answer 22

✅ Correct answer: B
➡️ Explanation: This rabbit fits the profile of the non-life-threatening group: mild hyperglycemia, normonatremia, and moderate gastric dilation without shock. According to the study, such cases were successfully treated with medical therapy alone (fluids, analgesia, prokinetics), without the need for decompression or surgery.

Question 23

CASE 1
A 2-year-old male rabbit presents with acute anorexia, apathy, and abdominal distension for 14 hours. Radiographs confirm gastric dilation. Blood gas reveals pH 7.18, low HCO₃⁻ and BE, normal pCO₂.
Question: What is the most likely acid-base abnormality in this rabbit?
A. Respiratory acidosis
B. Metabolic acidosis
C. Metabolic alkalosis

Answer 23

✅ Correct answer: B. Metabolic acidosis

Question 24

A rabbit presents 3 hours after onset of GI symptoms. Blood gas is normal. Owner refuses hospitalization. 10 hours later, the rabbit deteriorates. Repeat blood gas shows low BE and HCO₃⁻.
Question: What change is most likely to explain the rabbit’s worsening acid-base status?
A. Respiratory compensation with increased pCO₂
B. Development of metabolic acidosis due to delayed treatment
C. Hyperchloraemic alkalosis

Answer 24

✅ Correct answer: B. Development of metabolic acidosis due to delayed treatment

Question 25

A 3.2-year-old intact female rabbit is presented after 14 hours of anorexia, lethargy, and no fecal output. Physical exam reveals severe hypothermia (35.6°C), tachypnea (106 bpm), and poor skin turgor. Radiographs (see Fig. 1) show a markedly distended stomach with homogeneous ingesta and a central gas bubble, with gas-filled proximal duodenum. Blood gas analysis reveals: pH: 7.21 HCO₃⁻act: 13.6 mmol/L BEecf: –11.2 mmol/L pCO₂: 27.2 mmHg Glucose: 26.4 mmol/L Sodium: 136 mmol/L Lactate: not available What is the most appropriate interpretation and clinical step? A. The rabbit presents with compensated respiratory acidosis and requires oxygen support B. The findings support metabolic acidosis due to delayed presentation and gastric dilation; initiate intensive supportive therapy and assess for surgical need C. These values are not critical; conservative management and simethicone can be initiated

Answer 25

✅ Correct Answer: B ➡️ Rationale: The rabbit presents late (>12 h), with classic metabolic acidosis (low pH, HCO₃⁻, BE), hypothermia, and significant radiographic gastric dilation. The pCO₂ is decreased—likely due to respiratory compensation. According to the Brezina study, this acid-base pattern is associated with worse prognosis and justifies intensive medical stabilization and rapid reassessment for surgical intervention if no improvement.

Question 26

A 2.8-year-old neutered male rabbit is presented 5 hours after onset of anorexia and decreased fecal output. He is alert but mildly dehydrated and hypothermic (37.0°C). Four hours after contrast administration, the radiographs (see Fig. 2) show residual contrast in the stomach and contrast present in the caecum and rectum. Arterial blood gas analysis shows: pH: 7.37 HCO₃⁻act: 19.5 mmol/L BEecf: –2.4 mmol/L pCO₂: 33.8 mmHg Na⁺: 140 mmol/L Cl⁻: 102 mmol/L Glucose: 12.8 mmol/L What is the most appropriate interpretation and therapeutic recommendation? A. Normal acid-base status and contrast progression indicate stability; continue medical treatment and monitor B. The data reflect early decompensation with impending metabolic acidosis; prepare for surgical exploration C. The presence of residual contrast in the stomach after 4 hours confirms obstruction; start metoclopramide and force feeding

Answer 26

✅ Correct Answer: A ➡️ Rationale: This rabbit has normal acid-base status, normonatremia, mild hyperglycemia, and clear progression of contrast to the caecum, all of which strongly support effective conservative treatment. According to Brezina et al., patients in this category rarely progressed to surgery and normalized parameters with medical management alone.

Question 27

A 5.8-year-old neutered male rabbit is presented for a progressively firm abdominal mass noticed by the owner. The rabbit remains bright and active. On ultrasonography, a well-defined, thick-walled mass is visualized cranial to the bladder, with internal hyperechoic structures and distal acoustic shadowing. Hematology reveals mild leukocytosis, hypercalcemia, and thrombocytosis. Thoracic radiographs are unremarkable. Which is the most likely diagnosis based on the ultrasound and clinical findings? A. Mesenteric abscess B. Enteric duplication cyst C. Cecal neoplasia

Answer 27

✅ Correct answer: B. Enteric duplication cyst ➡️ Rationale: Hyperechoic structures with acoustic shadowing and lack of systemic signs point toward mineralized or necrotic content typical of a duplication cyst, not a standard abscess.

Question 28

During exploratory laparotomy of a 6-year-old rabbit with a caudal abdominal mass, a 5 cm ovoid structure is found adhered to adjacent intestinal loops but lacks luminal communication. The mass is excised intact after meticulous dissection using bipolar cautery. The capsule exudes thick, cream-colored fluid upon incision. What intraoperative finding supports a diagnosis of congenital enteric duplication cyst over other differentials such as neoplasia or abscess? A. Presence of purulent content B. Lack of shared blood supply with intestines C. Severe intestinal inflammation at the adhesion sites

Answer 28

✅ Correct answer: B. Lack of shared blood supply with intestines ➡️ Rationale: Enteric duplication cysts may be closely associated with intestines but are distinguished by having an independent vascular supply, making clean resection possible.