WikiVet English - User contributions [en]

Hiatal Hernia

2017-01-30T11:02:28Z

BaraStudent:

{{OpenPagesTop}}
==Introduction==
A hiatal hernia is an abnormality of the diaphragm that allows part of the stomach and the abdominal oesophagus to displace into the thoracic cavity. Two types of hiatal hernia have been recognised in the dog and cat:
:'''Sliding hiatal hernia''' (type I) - Cranial displacement of the distal oesophagus and stomach into the mediastinum through the oesophageal hiatus of the diaphragm. This is the most common form and it can occur in the dog and cat as a congenital or acquired lesion. Congenital hernias result from the incomplete fusion of the ''septum transversum'' (which forms the diaphragm) during early embryonic development.
:'''Para-oesophageal''' or '''Rolling hiatal hernia''' (type II) - Cranial displacement of the gastric fundus into mediastinum through the oesophageal hiatus but adjacent to the oesophagus and gastric cardia which remain in their normal positions. This form of hernia is rare in animals.

==Signalment==

'''Acquired''' hernias can occur in any breed of dog or cat and these often occur with disorders that cause increases in intra-abdominal pressure (such as chronic vomiting) or decreases in intrathoracic pressure (such as intermittent airway obstruction seen with [[Laryngeal Paralysis|laryngeal paralysis]] and [[Brachycephalic Airway Syndrome|brachycephalic obstructive airway syndrome]] (BOAS)).

Breeds of dog that develop '''congenital''' sliding hernias include Chinese Shar-peis and Chow-chows whereas brachycephalic dogs (such as English and French bulldogs) often develop acquired hernias.

==Diagnosis==
===Clinical Signs===
Some animals may be asymptomatic but otherwise clinical signs include:

'''Regurgitation''' due to impaired function of the herniated lower oesophageal sphincter

'''Hypersalivation''' related to regurgitation

'''Dyspnoea''' and '''coughing''' if the hernia is large and impinges on the lungs or if the animal develops aspiration pneumonia as a result of regurgitation

'''Dehydration''' and '''weight loss''' due to chronic regurgitation

===Diagnostic Imaging===
'''Plain survey radiographs''' may show a gas-filled soft tissue opacity in the caudodorsal thorax, continuous with the diaphragmatic margin. Secondary [[Megaoesophagus|megaoesophagus]] may develop in longstanding cases and an alveolar lung pattern may be apparent, especially cranio-ventrally, if the animal is developing aspiration pneumonia. '''Barium contrast studies''' may be used to confirm a diagnosis. Intermittent hiatal hernias can be difficult to detect and therefore it is sometimes necessary to put pressure on the abdomen during radiography to induce displacement of the stomach.

'''Fluoroscopy''' can be used to identify cases of intermittent herniation if the condition is still suspected after plain radiography.

'''Endoscopy''' may demonstrate cranial displacement of the lower oesophageal sphincter and a large oesophageal hiatus.

==Treatment==
If the hernia is acquired, the underlying cause should be treated.

===Medical Management===

Medical management should be initiated to reduce [[Oesophagitis|oesophagitis]] caused by regurgitation. Medical management can be continued for cases with acquired hernias and it may achieve success in some cases with congenital hernias. This approach involves the use of:
:'''[[Gastroprotective Drugs]]''' including oral sucralfate suspensions and gastric acid secretory inhibitors such as cimetidine, ranitidine or omeprazole.
:A '''low fat diet''' fed from a height will increase the tone of the lower oesophageal sphincter and increase the speed of gastric emptying, reducing the likelihood of regurgitation.
:'''Metaclopramide''' may also be used to increase the tone of the lower oesophageal sphincter.
:'''Antibiotics, nebulisation and coupage''' may be used to manage aspiration pneumonia.

===Surgical Management===
Surgical management can be used with congenital cases (after medical management has been attempted) and to treat the underlying cause in acquired cases.

'''Hernia repair''' is achieved via a cranial ventral coeliotomy. The oesophageal hiatus is exposed by transection of left triangular ligament (between the liver and diaphragm) and retraction of the liver. The phreno-oesophageal ligament is partially incised and the oesophagus is retracted into the abdomen until the lower oesopageal sphincter is identified. Sutures are then placed to reduce the size of the oesophageal hiatus. An '''oesophagopexy''' may also be performed (tacking the oesophagus to the left body wall) or a '''fundic gastropexy'''. A tube gastropexy has the added advantage of allowing cases to be fed if they are suffering from severe [[Oesophagitis|oesophagitis]] or oesophageal ulceration, and also allowing for decompression of the stomach in the early postoperative period..

'''Laryngeal surgery or correction of BOAS''' may be performed if this has contributed to the hernia.

==Prognosis==
Prognosis is good after surgical repair or aggressive medical management, but complete relief of clinical signs may not be possible.

{{Learning
|Vetstream = [https://www.vetstream.com/canis/Content/Disease/dis00644.asp, Hiatal hernia] [https://www.vetstream.com/canis/Content/Illustration/ill00366.asp, Hiatal hernia - barium contrast] [https://www.vetstream.com/canis/Content/Illustration/ill00365.asp, Hiatal hernia - radiograph]
|flashcards = [[Small Animal Soft Tissue Surgery Q&A 14]]
|literature search = [http://www.cabdirect.org/search.html?rowId=1&options1=AND&q1=Hiatal+&occuring1=title&rowId=2&options2=AND&q2=Hernia&occuring2=title&rowId=3&options3=AND&q3=&occuring3=freetext&x=55&y=10&publishedstart=yyyy&publishedend=yyyy&calendarInput=yyyy-mm-dd&la=any&it=any&show=all Hiatal Hernia publications]
}}

==References==
Fossum, T. W. et. al. (2007) '''Small Animal Surgery''' (Third Edition) ''Mosby Elsevier''
Hall, E.J, Simpson, J.W. and Williams, D.A. (2005) '''BSAVA Manual of Canine and Feline Gastroenterology (2nd Edition)''' ''BSAVA''
Nelson, R.W. and Couto, C.G. (2009) '''Small Animal Internal Medicine (Fourth Edition)''' ''Mosby Elsevier''

{{review}}

{{OpenPages}}

[[Category:Oesophagus_-_Pathology]]
[[Category:Oesophageal Diseases - Cat]][[Category:Peritoneal Cavity Diseases - Cat]][[Category:Peritoneal Cavity Diseases - Dog]][[Category:Oesophageal Diseases - Dog]]
[[Category:Expert_Review - Small Animal]]
[[Category:Peritoneal_Cavity_-_Developmental_Pathology]]
[[Category:Muscles - Developmental Pathology]]

[https://www.vetstream.com/canis/Content/Disease/dis00644.asp]

Equis

2016-12-22T10:46:04Z

BaraStudent:

[[File:Equis-title-logo.gif|left]]

'''[https://www.vetstream.com/treat/equis Vetstream Equis]''' is the ultimate horse specific clinical information resource for veterinary practices, which provides comprehensive peer reviewed clinical information (including text, pictures, videos and sounds) on the horse from over 285 leading clinicians worldwide.
===Contents===
* [https://www.vetstream.com/equis/browse/Anesthesia Anesthesia]
* [https://www.vetstream.com/equis/browse/BasicScience Basic Science]
* [https://www.vetstream.com/equis/browse/Behavior Behavior]
* [https://www.vetstream.com/equis/browse/Breeds Breeds]
* [https://www.vetstream.com/equis/browse/Cardiology Cardiology]
* [https://www.vetstream.com/equis/browse/Criticalcare Critical care]
* [https://www.vetstream.com/equis/browse/Dentistry Dentistry]
* [https://www.vetstream.com/equis/browse/Dermatology Dermatology]
* [https://www.vetstream.com/equis/browse/DiagnosticImaging Diagnostic imaging]
* [https://www.vetstream.com/equis/browse/Gastrohepatology Gastrohepatology]
* [https://www.vetstream.com/equis/browse/InternalMedicine Internal medicine]
* [https://www.vetstream.com/equis/browse/Laboratorymedicine Laboratory medicine]
* [https://www.vetstream.com/equis/browse/Lifestages Lifestages]
* [https://www.vetstream.com/equis/browse/Microbiology Microbiology]
* [https://www.vetstream.com/equis/browse/Musculoskeletal Musculoskeletal]
* [https://www.vetstream.com/equis/browse/Neurology Neurology]
* [https://www.vetstream.com/equis/browse/Nutrition Nutrition]
* [https://www.vetstream.com/equis/browse/Oncology Oncology]
* [https://www.vetstream.com/equis/browse/Ophthalmology Ophthalmology]
* [https://www.vetstream.com/equis/browse/Ownerinformation Owner information]
* [https://www.vetstream.com/equis/browse/Parasitology Parasitology]
* [https://www.vetstream.com/equis/browse/Pathology Pathology]
* [https://www.vetstream.com/equis/browse/PharmacologyandTherapeutics Pharmacology and Therapeutics]
* [https://www.vetstream.com/equis/browse/Reproduction Reproduction]
* [https://www.vetstream.com/equis/browse/Respiratory Respiratory]
* [https://www.vetstream.com/equis/browse/SurgeryOrthopedic Surgery - Orthopedic]
* [https://www.vetstream.com/equis/browse/Surgerysofttissue Surgery - Soft tissue]
* [https://www.vetstream.com/equis/browse/Toxicology Toxicology]
* [https://www.vetstream.com/equis/browse/Urinary Urinary]

{{Learning|Vetstream = [https://www.vetstream.com/ Vetstream]}}

Lapis

2016-12-22T10:45:33Z

BaraStudent:

[[File:Lapis-title-logo.gif|left]]

'''[https://www.vetstream.com/treat/lapis Vetstream Lapis]''' is the ultimate rabbit clinical information resource for rabbit and small animal veterinary practices, providing comprehensive peer reviewed clinical information (including text, pictures, videos and sounds) on the rabbit from over 75 leading clinicians worldwide.
===Contents===
* [https://www.vetstream.com/lapis/browse/Anesthesia Anesthesia]
* [https://www.vetstream.com/lapis/browse/Behavior Behavior]
* [https://www.vetstream.com/lapis/browse/Breeds Breeds]
* [https://www.vetstream.com/lapis/browse/Cardiology Cardiology]
* [https://www.vetstream.com/lapis/browse/Criticalcare Critical care]
* [https://www.vetstream.com/lapis/browse/Dentistry Dentistry]
* [https://www.vetstream.com/lapis/browse/Dermatology Dermatology]
* [https://www.vetstream.com/lapis/browse/DiagnosticAlgorithms Diagnostic algorithms]
* [https://www.vetstream.com/lapis/browse/Diagnosticimaging Diagnostic imaging]
* [https://www.vetstream.com/lapis/browse/Gastrohepatology Gastrohepatology]
* [https://www.vetstream.com/lapis/browse/Internalmedicine Internal medicine]
* [https://www.vetstream.com/lapis/browse/Laboratorymedicine Laboratory medicine]
* [https://www.vetstream.com/lapis/browse/Microbiology Microbiology]
* [https://www.vetstream.com/lapis/browse/Musculoskeletal Musculoskeletal]
* [https://www.vetstream.com/lapis/browse/Neurology Neurology]
* [https://www.vetstream.com/lapis/browse/Nutrition Nutrition]
* [https://www.vetstream.com/lapis/browse/Oncology Oncology]
* [https://www.vetstream.com/lapis/browse/Ophthalmology Ophthalmology]
* [https://www.vetstream.com/lapis/browse/Ownerinformation Owner information]
* [https://www.vetstream.com/lapis/browse/Parasitology Parasitology]
* [https://www.vetstream.com/lapis/browse/Pathology Pathology]
* [https://www.vetstream.com/lapis/browse/PharmacologyandTherapeutics Pharmacology and Therapeutics]
* [https://www.vetstream.com/lapis/browse/Reproduction Reproduction]
* [https://www.vetstream.com/lapis/browse/Respiratory Respiratory]
* [https://www.vetstream.com/lapis/browse/Surgeryorthopedic Surgery - orthopedic]
* [https://www.vetstream.com/lapis/browse/Surgerysofttissue Surgery - soft tissue]
* [https://www.vetstream.com/lapis/browse/Toxicology Toxicology]
* [https://www.vetstream.com/lapis/browse/Urinary Urinary]

{{Learning|Vetstream = [https://www.vetstream.com/ Vetstream]}}

Felis

2016-12-22T10:44:54Z

BaraStudent:

[[File:Felis-title-logo.gif|left]]

'''[https://www.vetstream.com/treat/felis Vetstream Felis]''' is the ultimate feline clinical information resource for cat based small animal veterinary practices, providing comprehensive peer reviewed clinical information (including text, pictures, videos and sounds) on the cat from over 350 leading clinicians worldwide.
===Contents===
* [https://www.vetstream.com/felis/browse/Anesthesia Anesthesia]
* [https://www.vetstream.com/felis/browse/BasicScience Basic Science]
* [https://www.vetstream.com/felis/browse/Behavior Behavior]
* [https://www.vetstream.com/felis/browse/Breeds Breeds]
* [https://www.vetstream.com/felis/browse/Cardiology Cardiology]
* [https://www.vetstream.com/felis/browse/Criticalcare Critical care]
* [https://www.vetstream.com/felis/browse/Dentistry Dentistry]
* [https://www.vetstream.com/felis/browse/Dermatology Dermatology]
* [https://www.vetstream.com/felis/browse/DiagnosticImaging Diagnostic imaging]
* [https://www.vetstream.com/felis/browse/DiagnosticAlgorithms Diagnostic algorithms]
* [https://www.vetstream.com/felis/browse/Gastrohepatology Gastrohepatology]
* [https://www.vetstream.com/felis/browse/InternalMedicine Internal medicine]
* [https://www.vetstream.com/felis/browse/Laboratorymedicine Laboratory medicine]
* [https://www.vetstream.com/felis/browse/Lifestages Lifestages]
* [https://www.vetstream.com/felis/browse/Microbiology Microbiology]
* [https://www.vetstream.com/felis/browse/Musculoskeletal Musculoskeletal]
* [https://www.vetstream.com/felis/browse/Neurology Neurology]
* [https://www.vetstream.com/felis/browse/Nutrition Nutrition]
* [https://www.vetstream.com/felis/browse/Oncology Oncology]
* [https://www.vetstream.com/felis/browse/Ophthalmology Ophthalmology]
* [https://www.vetstream.com/felis/browse/Ownerinformation Owner information]
* [https://www.vetstream.com/felis/browse/Parasitology Parasitology]
* [https://www.vetstream.com/felis/browse/Pathology Pathology]
* [https://www.vetstream.com/felis/browse/PharmacologyandTherapeutics Pharmacology and Therapeutics]
* [https://www.vetstream.com/felis/browse/Reproduction Reproduction]
* [https://www.vetstream.com/felis/browse/Respiratory Respiratory]
* [https://www.vetstream.com/felis/browse/SurgeryOrthopedic Surgery - Orthopedic]
* [https://www.vetstream.com/felis/browse/Surgerysofttissue Surgery - Soft tissue]
* [https://www.vetstream.com/felis/browse/Toxicology Toxicology]
* [https://www.vetstream.com/felis/browse/Urinary Urinary]

{{Learning|Vetstream = [https://www.vetstream.com/ Vetstream]}}

Canis

2016-12-22T10:44:14Z

BaraStudent:

[[File:Canis-title-logo.gif|left]]

'''[https://www.vetstream.com/treat/canis Vetstream Canis]''' is the ultimate canine clinical information resource for dog based small animal veterinary practices, providing comprehensive peer reviewed clinical information (including text, pictures, videos and sounds) on the dog from over 500 leading clinicians worldwide.
===Contents===
* [https://www.vetstream.com/treat/canis/categories/anesthesia?u=wikivetstudent Anesthesia]
* [https://www.vetstream.com/canis/browse/BasicScience/?u=wikivetstudent Basic Science]
* [https://www.vetstream.com/canis/browse/Behavior Behavior]
* [https://www.vetstream.com/canis/browse/Breeds Breeds]
* [https://www.vetstream.com/canis/browse/Cardiology Cardiology]
* [https://www.vetstream.com/canis/browse/Criticalcare Critical care]
* [https://www.vetstream.com/canis/browse/Dentistry Dentistry]
* [https://www.vetstream.com/canis/browse/Dermatology Dermatology]
* [https://www.vetstream.com/canis/browse/Diagnosticalgorithms Diagnostic algorithms]
* [https://www.vetstream.com/canis/browse/DiagnosticImaging Diagnostic imaging]
* [https://www.vetstream.com/canis/browse/Gastrohepatology Gastrohepatology]
* [https://www.vetstream.com/canis/browse/InternalMedicine Internal medicine]
* [https://www.vetstream.com/canis/browse/Laboratorymedicine Laboratory medicine]
* [https://www.vetstream.com/canis/browse/Lifestages Lifestages]
* [https://www.vetstream.com/canis/browse/Microbiology Microbiology]
* [https://www.vetstream.com/canis/browse/Musculoskeletal Musculoskeletal]
* [https://www.vetstream.com/canis/browse/Neurology Neurology]
* [https://www.vetstream.com/canis/browse/Nutrition Nutrition]
* [https://www.vetstream.com/canis/browse/Oncology Oncology]
* [https://www.vetstream.com/canis/browse/Ophthalmology Ophthalmology]
* [https://www.vetstream.com/canis/browse/Ownerinformation Owner information]
* [https://www.vetstream.com/canis/browse/Parasitology Parasitology]
* [https://www.vetstream.com/canis/browse/Pathology Pathology]
* [https://www.vetstream.com/canis/browse/PharmacologyandTherapeutics Pharmacology and Therapeutics]
* [https://www.vetstream.com/canis/browse/Reproduction Reproduction]
* [https://www.vetstream.com/canis/browse/Respiratory Respiratory]
* [https://www.vetstream.com/canis/browse/SurgeryOrthopedic Surgery - Orthopedic]
* [https://www.vetstream.com/canis/browse/Surgerysofttissue Surgery - Soft tissue]
* [https://www.vetstream.com/canis/browse/Toxicology Toxicology]
* [https://www.vetstream.com/canis/browse/Urinary Urinary]

{{Learning|Vetstream = [https://www.vetstream.com/ Vetstream]}}

Feline Panleucopenia

2016-01-19T09:51:14Z

BaraStudent: /* Links */

{{OpenPagesTop}}
Also known as: '''''Feline Infectious Enteritis — Feline Parvovirus — FPV — Panleukopenia

==Description==
Feline panleucopenia is a viral infection of cats caused by '''feline parvovirus (FPV)'''. Feline parvovirus is a small, non-enveloped, single-stranded DNA virus of one serotype only, that is closely related to [[Canine Parvovirus|canine parvovirus type 2 (CPV-2)]]. CPV-2 is also responsible itself for some cases of feline panleucopenia. In order to replicate, FPV must infect dividing cells, and so tissues with a high mitotic rate undergo acute cytolysis. FPV is very stable in the environment and may survive for years on infected premises. It is also highly contagious.

Feline panleucopenia takes its name from the severe depletion of leucocytes that results from FPV infection. As well as targeting immune cells, FPV destroys the cells of the intestinal crypts causing enteritis, villous atrophy and malabsorption. ''In utero'' infection of foetuses can occur, leading to foetal death, resorption, mummification, abortion or stillbirth. In neonatal kitten the retinal cells of the eye and the granular cells of the epithelium are rapidly dividing. Infection of these by FPV causes permanent retinal dysplasia and cerebellar hypoplasia.

==Signalment==
Although routine [[Vaccines|vaccination]] can give almost complete control of feline panleucopenia, the disease is seen worldwide in unvaccinated populations. All domestic and exotic felids may contract FPV, as well as some exotic canids. Mink are particularly susceptible, and infection may also be seen in racoons, pandas and coatimundi. Although there are no breed or sex predilections, the severity of disease varies with age. Once maternal immunity has waned, unvaccinated, previously unexposed cats can become infected at any age. However, severe infections are most likely in kittens of 2-6 months of age, and adults usually suffer from mild or subclinical disease.

==Diagnosis==
A presumptive diagnosis can be made on the basis of clinical signs, vaccination status, age, exposure and the presence of a severe panleucopenia. Laboratory tests are available to confirm the diagnosis.

===Clinical Signs===
The clinical signs of feline panleucopenia can vary in severity, particularly between ages of cat. It is therefore important to remember that especially in adult animals, disease may be mild or even subclinical.

Certain elements of a patient's history may be suggestive of feline panleucopenia. For example, the animal may have recently been exposed to a potential source of infection, such as a cattery, or be a kitten obtained from a premises with a history of feline panleucopenia. Lack of vaccination, or vaccination before the demise of maternally-derived antibodies, may also point to FPV infection. Owners usually report a sudden onset of illness including '''[[vomiting]], [[diarrhoea]], depression''' and complete '''anorexia''', and cats are often said to hang their head over the food or water bowl but do not actually eat or drink.

On clinical examination, cats show varying degrees of depression and are often severely dehydrated. Vomiting and diarrhoea may be apparent and body temperature can be mildly to moderately elevated or depressed in the early stages of disease. When the cat becomes severely ill, a markedly subnormal temperature is seen. Animals are often painful on abdominal palpation, and the small intestine can be felt to be either abnormally flaccid or turgid due to fluid or gas filling. A typical "hunched up" posture is adopted by affected kittens. Damage to the enteric mucosal integrity can lead to secondary infections and sepsis and perforation of the gut can cause peritonitis.

Infection of the pregnant queen may result in ''in utero'' infection of kittens. When this occurs in early to mid gestation, foetal death, resorbtion, abortion or mummification can occur. Infection of kittens in late gestation or early in neonatal life may give cerebellar hypoplasia. This becomes apparent at around 10-14 days old. Affected kittens are ataxic with a wide-based stance, in-coordination and tremors, and these signs persist for life. Apart from occasional retinal dysplasia, these cats are otherwise normal and healthy and are said to make good pets.

A per acute presentation of disease is possible, where kittens are found dead with little or no evidence of preceding enteritis.

There are several differential diagnoses for feline panleucopenia. These include feline lymphoma virus, Salmonellosis and acute poisoning. Many other diseases cause vague signs which are similar to mild feline panleucopenia infection. The fact that white blood cell count is always low even in mild cases of feline panleucopenia can be used to differentiate this condition from others.

===Laboratory Tests===
On haemotology, a '''striking panleucopenia''' is the most consistent finding and [[neutrophils]] are particularly depleted. [[Leucocytes|Leucocyte]] counts are usually between 500 and 3000 cells per decilitre. Routine biochemistry is not associated with any specific changes.

Paired serum sampling should reveal a rising antibody titre to FPV during an acute infection. A CITE test can also be used to quickly detect FPV antigen in the faeces, although this is only truly licensed for use for canine parvovirus. Confirmation of diagnosis is by virus isolation or PCR of viral antigen using faeces, infected tissue, oropharyngeal swabs or post-mortem material.

===Pathology===
Macroscopically, the hair coat is seen to be rough, body condition is poor and there is evidence of severe dehydration. Faecal staining may be suggestive of diarrhoea during life. The intestine itself is oedematous and petechial or ecchymotic haemorrhages may be seen on the serosal or mucosal surfaces of the jejunum and ileum. Thymic atrophy is apparent, lymph nodes are pale and oedematous and the bone marrow is gelatinous or liquid in texture. Animals infected ''in utero'' or neonatally nay show gross hypoplasia of the cerebellum.

Histologically, the cells lining the intestinal crypts undergo complete necrosis and sloughing, but little inflammation is seen. The villi are shortened and blunted (villous atrophy) and fibrinous exudates may be seen on surface of the mucosa. There is an absence of lymphocytic infiltrates in all tissues and lymphoid depletion of lymph nodes, Peyer's patches and the spleen. Eosinophilic intranuclear inclusion bodies are formed during the early stages of infection, but these are usually not possible to observe on routine examination of sections. In neonatal and foetal infections, the granular and Purkinje cells of the cerebellum may be depleted.

==Treatment==
Treatment relies on supportive care. The aims of this are to rehydrate the animal, to re-establish electrolyte balances and to support the animal until the immune system produces antibodies to neutralise FPV. '''Intensive intra-venous fluid therapy''' is therefore essential, and fluids can be spiked with electrolytes to restore the animals balance. A blood tranfusion may also be necessary if the totaly leucocyte count falls below 2000 cells per decilitre. The kitten should be maintained within a warm clean environment, and food withheld until the gastroenteritis is controlled, when a simple, moist diet should be gradually reintroduced. Drug therapy should involve broad-spectrum antibiosis to control secondary bacteraemias, gastric protectants, anti-emetics and B-vitamin supplements. Feline interferon omega can be helpful but is often cost-preclusive. Barrier nursing and effective cleaning and disinfection of the environment with household bleach is of paramount importance.

Feline panleucopenia is completely preventable by routine vaccination of kittens. Modified live vaccines are most commonly used, and should be given once at 8-12 weeks of age, and a second time 3-4 weeks later. It has also been advised to give a third dose once the kitten is over 16 weeks of age, to ensure that maternally transferred immunity does not interfere with the vaccine. Cats older than 16 weeks at the beginning of the course need two injections only. Boosting is required at one year, and then every one to three years after the first year.

==Prognosis==
Most acute cases last around 5-7 days. Although prognosis is guarded during acute disease, recovery is generally rapid if death does not result. It may, however, take several weeks for the animal to regain the body condition lost during the illness.

==Links==
*[http://www.avma.org/animal_health/brochures/panleukopenia/panleukopenia_brochure.asp| AVMA Feline Panleuopenia Factsheet]

{{Learning
|literature search = [http://www.cabdirect.org/search.html?q=%28title%3A%28%22Panleucopenia%22%29+OR+title%3A%28panleucopaenia%29+OR+title%3A%28panleukopaenia%29+OR+title%3A%28panleukopenia%29+OR+title%3A%28%22Infectious+Enteritis%22%29+OR+title%3A%28%22Feline+Parvovirus%22%29+OR+title%3A%28FPV%29%29+AND+od%3A%28cats%29 Feline Panleukopenia publications]
|Vetstream = [https://www.vetstream.com/felis/Content/Bug/bug60013 Feline panleukopenia (parvo)] [https://www.vetstream.com/felis/Content/Disease/dis60167 Feline panleukopenia virus disease]
}}

==References==
#Tilley, L.P. and Smith, F.W.K.(2004)'''The 5-minute Veterinary Consult (Third edition)''' ''Lippincott, Williams & Wilkins''.
#Merck & Co (2008) '''The Merck Veterinary Manual (Eighth Edition)''' ''Merial''

{{review}}

{{OpenPages}}

[[Category:Parvoviridae]][[Category:Cat Viruses]][[Category:Intestinal Diseases - Cat]]

[[Category:Expert_Review]]

Feline Leukaemia Virus

2016-01-19T09:48:37Z

BaraStudent:

Also known as '''''FeLV
[[Image:FeLV Electron Micrograph.jpg|thumb|right|175px|FeLV Electron Micrograph [http://phil.cdc.gov/phil/home.asp Public Health Image Library] Image #5610]]

==Introduction==
[[Image:Kinetics of FeLV 2.jpg|thumb|right|200px|Kinetics of FeLV - Copyright Dr Brian Catchpole BVetMed PhD MRCVS]]
FeLV is an oncogenic mammalian type C retrovirus which causes neoplasia ([[Lymphoma|lymphoma]]), myelosuppression ([[Regenerative and Non-Regenerative Anaemias|anaemia]]) and immunosuppression (of [[Lymphocytes#T cells|T cells]]). Three different strains are currently recognised:
*FeLV-A -natural strain
*FeLV-B which formed through FeLV-A recombining with endogenous retroviral sequences in the feline genome.
*FeLV-C which formed from the spontaneous mutation of FeLV-A

The virus replicates in the oropharyngeal lymphoid tissue causing a viraemia (the virus circulates in the bloodstream) which then spreads to the systemic lymphoid tissue.

==Pathogenesis==
FeLV is the "disease of friends": transmission usually occurs through mutual grooming. From the oropharynx, the virus spreads to most tissues in the body to replicate, notably:
*Bone marrow
*Thymus
*Salivary glands
*Reproductive tract
Most kittens but only 30% of adults become '''viraemic''' for life without producing antibody. The condition progresses in various forms:
*20% of viraemic cats die of tumors
*30% of viraemic cats die of FeLV-associated disease
*80% die within three years of exposure
30% of adults exposed become '''latently infected''' and can become viraemic when immunosuppressed.
40% of exposed adults remain healthy and develop Ab and CD8+ T cells after clearing the virus, without becoming reinfected or silent carriers.

==Clinical Signs==
*'''Leukemia''' - a neoplastic increase in blood cell numbers - usually white blood cells
*'''Multicentric lymphosarcoma''': B or T cell tumors, which may be palpable as enlarged lymph nodes (particularly mesenteric)
*'''Thymic lymphosarcoma''': T cell tumors, with only the thymus enlarged -this may result in dyspnoea and can be confirmed by radiography
*'''Alimentary lymphosarcoma''': B cell tumors of the Peyer's patches

*Cutaneous horns on foot pads
*Epidermal and follicular epithelial hyperplasia, epidermal giant cells, dyskeratosis, necrosis, ulceration

FeLV-associated disease:
*'''Immunodepression''' causing secondary disease
*'''Reproductive failure''': FeLV crosses the placenta, causing fetal resorption or viraemic kittens with thymic aplasia

==Epidemiology==
Vertical transmission of FeLV-A occurs from mother to kittens either via placenta, grooming, or milk. Horizontal transmission occurs via saliva during mutual grooming. FeLV is of particular concern for intensively bred cats because of close living conditions shared with other cats.

Recovery is linked to age and the presence of maternal antibody

==Antigenicity==
Viral subgroups have been categorised based on the different abnormalities detected in the host cellular envelope protein gp70. This protein interacts with a cellular receptor, and can prevent already infected cells from being targeted by further viral organisms.

There are 3 antigenic subgroups which are defined by the gp70 regulated viral response:
*Group A is transmitted between cats and is monotypic: one vaccine covers all isolates. Infection with this viral subgroup leads to '''[[Lymphoma|lymphosarcoma]]'''.
*Group B is recombinant with transmissible FeLV-A; infection with viruses of this subgroup increases the chance of developing '''[[Thymus Neoplasia|thymic tumours]]'''.
*Group C is a mutant of subgroup A. Isolates are rare, and occur as A+C mixes, leading to an increased chance of developing '''[[Regenerative and Non-Regenerative Anaemias|anaemia]]'''.

==Diagnosis==
*FeLV should be suspect in any cat with '''recurrent bacterial infections''', '''anemia''' or '''weight loss'''. Diagnostic tests available for confirmation of disease status include:
*'''[[ELISA testing|ELISA]]''' for FeLV antigens (capsid protein p27 or envelope protein gp70)
*'''Immunochromatography''' is now preferred as ELISA testing can give false positives
*'''Virus isolation''' from heparinised blood can be performed to confirm a positive diagnosis
*[[Immunofluorescence]]
*PCR
*Rapid-Immuno-Migration
*[[Western blot|Western Blot]]

==Infection Control==
Antigen positive cats with significant symptoms require euthanasia. Healthy positive cats should have the diagnosis confirmed by a second alternate testing method.

===Vaccination===
Ideally, this should take place once antigen-negative status has been determined by laboratory testing. 'Leukogen' is a subunit vaccine (using envelope protein gp70) produced in ''E. coli'' mixed with Quill-A and alhydrogel. Others include inactivated virus and canarypox recombinants, but all MUST include FeLV-A.

==Treatment==
Where treatment is undertaken, anti-retroviral therapy is indicated with antibiotics to control secondary infections. Prevention is a key element in the control and treatment of FeLV overall.

{{Learning
|Vetstream = [https://www.vetstream.com/felis/Content/Disease/dis60141 Feline leukemia virus disease]
}}

[[Category:Mammalian Type C retrovirus ]][[Category:Cat Viruses]][[Category:Lymphoreticular and Haematopoietic Diseases - Cat]][[Category:Alimentary Diseases - Cat]][[Category:Secondary Immunodeficiency]]
[[Category:Lymphoreticular and Haemopoietic Diseases]]
[[Category:Anaemia]]
[[Category:Integumentary System - Viral Infections]]

Feline Infectious Peritonitis

2016-01-19T09:46:34Z

BaraStudent: /* Prognosis */

{{OpenPagesTop}}
Also known as: '''''FIP'''

==Introduction==
A progressive disease of the cat caused by feline [[Coronaviridae|coronavirus]]. FIP arises from a mutation of '''Feline Enteric Coronavirus (FECoV)''' in 5-10% of chronically infected cats and not directly from cat to cat. Two forms of the disease exist the '''wet''' or '''exudative form''' and the '''dry''' or '''non exudative form'''.

==Signalment==
Domestic and wild cats.

Cats compromised by immunosuppression (either iatrogenic or disease-related) are at a greater risk of developing FIP.

==History and Clinical signs==
FECoV may cause mild respiratory signs and diarrhoea but is often asymptomatic.

Signs of FIP include, chronic weight loss, anorexia, pyrexia, depression, fever and [[Vasculitis|vasculitis]].
Fluid in the abdomen, thorax or pericardium are symptomatic of wet FIP.
Granulomatous change in the organs are symptomatic of dry FIP.
FIP has also been documented to cause:
Uveitis, [[Congenital and Neonatal Disease - Pathology #Hydrocephalus| hydrocephalus]], neurological symptoms, such as ataxia or [[Seizures|seizures]] and chronic [[Diarrhoea|diarrhoea]].

==Diagnosis==
FIP should be suspected in all cases of chronic weight loss or recurrent fever unresponsive to antibiotics, particularly in multiple cat situations.
Simple serology is impossible as most cats will have antibody to FECoV.

===Laboratory Tests===
Four indicators can be used for diagnosis:
*High FECoV Antibody titres
*Low albumin:globulin ratio in plasma/ascites (globulin levels rise in FIP)
*High levels of glycoprotein alpha 1-acid glycoprotein (AGP)
*Low white cell counts
FIP antigen detection by immunofluorescence in macrophages gives a definite positive diagnosis

==Pathogenesis==
Weeks, months or years may intervene between localized primary FECoV infection and FIP development. FECoV replicates in the gut, but FIP spreads systemically in the circulation. FIP then gains the ability to replicate in [[Monocytes|monocytes]] and macrophages.

Failure of the [[:Category:Adaptive Immune System|immune system]] to clear antibody-antigen complexes leads to immune-mediated disease and deposited complexes cause [[Inflammation - Pathology|inflammation]] and exudation. This leads to characteristic [[Oedema| oedema]] as fibrin-rich serum escapes to intercellular spaces.

Pyogranulomas reactions can develop in major organs as a result of the immune response and the body's failure to clear away excess [[Neutrophils|neutrophils]].

Cats previously exposed to coronavirus (and therefore with circulating antibody) may be at greater risk as they are more susceptible to taking up virus into mononuclear cells.

Cats making a biased [[Adaptive Immune System - Overview#Cellular response: Proliferation and Differentiation|Th-1]] response are more likely to evade infection, whereas cats making a balanced response are at moderate risk and cats making a biased [[Adaptive Immune System - Overview#Cellular response: Proliferation and Differentiation| Th-2]] response are at greater risk, as the virus is best tackled by cell mediation and not antibody.

==Pathology==

====Gross====
'''Wet form'''

Widespread miliary, white, pinhead granulomas and fibrin deposition, particularly in the serosa of the [[Small Intestine Overview - Anatomy & Physiology|small]] and [[Large Intestine - Anatomy & Physiology |large intestine]]
High-protein exudates can be found in [[Peritoneal Cavity - Anatomy & Physiology|peritoneal cavity]].

'''Dry form'''

Larger, grey granulomatous masses are found in abdominal organs, including the [[Small Intestine Overview - Anatomy & Physiology|small]] and [[Large Intestine - Anatomy & Physiology|large intestine]], kidneys, liver and mesenteric lymph nodes. CNS and ocular involvement occurs in up to 60% of cases, with granulomas causing the clinical signs.

====Histological====
Multifocal pyogranulomas on serosa and throughout gut wall. Infiltration by mononuclear cells, [[Lymphocytes - Introduction|lymphocytes]], plasma cells, [[Macrophages| macrophages]] and a few [[Neutrophils|neutrophils]]. [[Necrosis - Pathology|Necrosis]] and vasculitis will also be seen.

==Treatment==
Immunomodulators including interferon have been used to control the virus and Dr. Diane Addie at Glasgow vet school has found that cats do respond to this form of treatment.

Immunosuppressive drugs such as [[Steroids| prednisolone]] or cyclophosphamide may slow disease progression.

Cats should recieve widespread [[Antibiotics|antibiotics]] and suppotive therapy.

The disease is almost invariably fatal.

==Control==
Conventional [[Vaccines| vaccination]] is counterproductive as antibody worsens infection however a non-systemic vaccine (Primucell) is available outside the UK. Replication confined to nasal mucosa, providing local immunity and cell-mediated immunity and it cannot protect cats already infected with FECoV.

Antibody tests are available to certify FECoV-free cat houses.

Recommendations for control and prevention include:
:keeping cats in small stable groups
:good litter tray hygiene to prevent faeco-oral transmission
:reducing stress and minimising concurrent diseases
:avoid breeding from cats that previously produced kittens that succumbed to FIP.

Eliminating FIP from a cattery that has had a case is difficult, but involves closing the cattery to new arrivals and restricting movement within the buildlings. Attempts to produce FCoV-free kittens from an FCoV positive queen can be made through isolation of the queen and kittens combined with early weaning of the kittens at 5-6 weeks of age. But there is a high risk that poorly socialised kittens are produced.

Even once the cattery is free from FCoV, the long-term maintenance of this is any multicat household is extremely difficult.

==Prognosis==
Very poor.

{{Learning
|flashcards = [[Small Animal Abdominal and Metabolic Disorders Q&A 13]] [[Feline Medicine Q&A 16]] [[Feline Medicine Q&A 22]]
|literature search =[http://www.cabdirect.org/search.html?q=title%3A%28%22Feline+Infectious+Peritonitis%22%29+OR+title%3A%28FIP%29+AND+od%3A%28cats%29 Feline Infectious Peritonitis publications]
|Vetstream = [https://www.vetstream.com/felis/Content/Disease/dis60142 Feline infectious peritonitis]
}}

==References==
Ettinger, S.J, Feldman, E.C. (2005) '''Textbook of Veterinary Internal Medicine''' (6th edition, volume 2) ''W.B. Saunders Company''

Nelson, R.W. and Couto, C.G. (2009) '''Small Animal Internal Medicine''' (Fourth Edition) ''Mosby Elsevier''

{{review}}

{{OpenPages}}

[[Category:Coronaviridae]][[Category:Cat Viruses]]
[[Category:Enteritis, Granulomatous]]
[[Category:Enteritis,_Viral]]
[[Category:Hepatitis,_Viral]]
[[Category:Peritoneal Cavity Diseases - Cat]]
[[Category:Expert_Review - Small Animal]]
[[Category:Lymphoreticular and Haemopoietic Diseases]]

Feline Infectious Anaemia

2016-01-19T09:44:34Z

BaraStudent: /* Prognosis */

{{OpenPagesTop}}
{{Summary
|cause = ''Mycoplasma haemofelis''
|signalment = Male cats with outdoor access
|associated = Feline retroviruses
|differentials = Other causes of anaemia
|diagnosis = PCR, blood smear examination
|treatment = Doxycycline
}}
Also known as: '''''FIA — Haemoplasmosis — Hemoplasmosis'''''; previously known as: ''Haemobartonellosis''

Caused by: '''''Mycoplasma haemofelis (Mhf)''''' (previously known as ''Haemobartonella felis''), '''''Candidatus M. haemominutum (Mhm) — Candidatus M. turicensis (Mtc)'''''

==Introduction==
Feline Infectious Anaemia is a [[Regenerative_and_Non-Regenerative_Anaemias|regenerative anaemia]] of cats caused by '''''Mycoplasma haemofelis''''' (Mhf). The disease occurs worldwide and should be considered as a differential diagnosis for any cat presenting with anaemia.

==Aetiology==
Mhf is one of a group of organisms known as haemotropic [[Mycoplasmas|mycoplasmas]] which infect many mammalian species. The causative organism was previously called ''Haemobartonella felis'' and thus the disease was known as haemobartonellosis. [[Polymerase_Chain_Reaction|Polymerase chain reaction]] (PCR) assays allowing DNA analysis resulted in the reclassification of the organism as a mycoplasma in 2001<ref name="Niemark">Niemark H, Johansson KE, Rikihisa Y, et al (2001) Proposal to transfer some members of the genera ''Haemobartonella'' and ''Eperythrozoon'' to the genus ''Mycoplasma'' with descriptions of Candidatus ''Mycoplasma haemofelis'', Candidatus ''Mycoplasma haemomuris'', Candidatus ''Mycoplasma haemosuis'' and Candidatus ''Mycoplasma wenyonii'' '''Int J Sys Evol Microbiol 51(3) pp891-9</ref>. Two other haemotropic mycoplasmas (''Candidatus M. haemominutum'' (Mhm) and ''Candidatus M. turicensis'' (Mtc)) have also been identified in cats but appear to be less pathogenic<ref name="Sykes">Sykes, JE (2010) Feline Hemotropic Mycoplasmas '''Vet Clinics of North America: Small Animal Practice''' pp. 1157-1170</ref>.

Mhf can vary in shape from cocci to rods and is sometimes present as chains of organisms on the surface of [[Erythrocyte|erythrocytes]].

[[File:M haemofelis2.jpg|thumb|''Mycoplasma haemofelis'' on the surface of an erythrocyte]]

==Transmission==

The mode of transmission of Mhf is poorly understood. Several possibilities have been proposed but none have been able to be reliably demonstrated. These include:
* Biting and fighting activities. Infection by this route has not been able to be demonstrated experimentally.
*[[Fleas|Fleas]]. The fact that Mhf infection can be prevalent in areas where fleas are uncommon makes this less likely.<ref name="Jensen"> Jensen WA, Lappin MR, Kamkar S et al (2001) Use of a polymerase chain reaction assay to detect and differentiate two strains of ''Haemobartonella felis'' in naturally infected cats. '''Am J Vet Res''' 62(4):604-8 </ref>
*[[Arthropods|Arthropods]]. Geographic variation in rates of Mhf infection does exist and could be due to transmission by an arthropod. <ref name="Willi">Willi B, Boretti FS, Baumgartner C et al (2006) Prevalence, risk factor analysis and follow-up of infections caused by three feline haemoplasma species in Switzerland. '''J Clin Microbiol''' 44(3):961-9</ref>

As transmission has been shown to occur through blood transfusion due to the ability of the organism to survive in stored blood products for up to 7 days <ref name="Gary">Gary AT, Richmond HL, Tasker S etal (2006) Survival of ''Mycoplsma haemofelis'' and ''Candidatus'' Mycolplasma haemominitum in blood of cats used for transfusions '''J Feline Med Surg''' 8(5):321-6</ref>, it is recommended that blood donors be screened.<ref name="Wardrop">Wardrop J, Reine N, Birkenheuer A et al (2005) Canine and feline blood donor screening for infectious disease '''J Vet Intern Med''' 19(1) pp.135-42.</ref>

==Signalment==
The major group at risk for Mhf infection are young male cats who spend time outdoors. In many areas of the world an association has been shown between Mhf and [[Retroviridae|retroviral infections]]<ref name="Sykes" />. It has been demonstrated that cats infected with Mhf and [[Feline_Leukaemia_Virus|feline leukaemia virus (FeLV)]] are likely to develop more severe anaemia that cats infected only with Mhf <ref name="Wardrop"></ref>.

==Pathogenesis==
The pathogenesis of Mhf is not fully understood. It is thought that the presence of the parasite on the surface of the erythrocytes may induce [[Immunoglobulins_-_Overview|antibody production]]<ref name="Hagiwara"></ref>, resulting in [[Regenerative_and_Non-Regenerative_Anaemias#Haemolysis|haemolysis]] which is primarily extravascular. The haemolysis may be due to direct damage of erythrocytes by the organism or as a result of the antibodies produced by the infected animal <ref name="Wardrop"></ref>.

Cats can produce an immune response which results in the disappearance of organisms from the blood. Production of uninfected erythrocytes can then result in an increase in [[haematocrit]].

It is thought that recovered cats can become subclinical carriers, with the potential for the disease to recrudesce if the animal is in a stressed state eg pregnancy, illness.<ref name = "Harvey">Harvey JW and Gaskin JM (1978)Feline haemobartonellosis;attempts to induce relapses of clinical disease in chronically infected cats.'''J Am Anim Hosp Assoc'''14:453</ref>

[[File:M haemofelis.jpg|thumb|''Mycoplasma haemofelis'' on the surface of blood cells]]

==Clinical signs==

Infected cats most commonly present for lethargy and decreased appetite. Physical examination findings are non-specific and can include signs of anaemia, such as mucous membrane pallor, tachypnoea and tachycardia, pyrexia, and occasionally splenomegaly and [[Icterus|jaundice]]. Pyrexia is frequently intermittent and spikes when parasite numbers are highest <ref name="Wardrop"></ref>. The anaemia can be severe and rapidly fatal in some cases.

==Differential diagnosis==
There are multiple causes of both [[Regenerative and Non-Regenerative Anaemias|regenerative and non-regenerative anaemia]] in cats which must be considered as differential diagnoses.

For cats showing signs of regeneration, causes of blood loss or haemolysis must be considered:
*[[Immune_Mediated_Haemolytic_Anaemia|primary immune-mediated haemolytic anaemia]]
*Heinz body haemolytic anaemia (onions, garlic, [[propofol]])
*other infectious causes such as [[Babesia|''Babesia felis'']] and [[Cytauxzoon#Cytauxzoon_felis|''Cytauxzoon felis'']]
*[[Neoplasia_-_Pathology|neoplasia]]

Major differential diagnoses for cats with non-regenerative anaemia include:
*neoplasia
*chronic inflammatory conditions
*underlying conditions such as [[Diabetes_Mellitus|diabetes mellitus]] and [[Chronic_Renal_Failure|renal disease]]
*[[FIV|Feline Immunodeficiency Virus(FIV)]] and [[FeLV]] infections
*[[Regenerative_and_Non-Regenerative_Anaemias#Failure_of_the_bone_marrow_stem_cells_to_produce_erythroid_cells|bone marrow diseases]]

==Diagnosis==

The most commmon findings from complete blood counts from cats with Mhf infections are a '''macrocytic, hypochromic regenerative anaemia'''. [[Reticulocyte|Reticulocytes]] and [[Howell-Jolly Bodies|Howell-Jolly bodies]] may be identified on cytologic examination.

Mhf infection can be definitively diagnosed by identification of organisms on a blood smear, appearing as cocci or rods and sometimes forming short chains of organisms. However, examination of a single blood smear is less than 50% sensitive <ref name="Hagiwara"> Hagiwara, MK (2009) Anemia in Cats: Is It Mycoplasma? '''Proceedings of the 34th World Small Animal Veterinary Congress'''</ref> as the animal's immune response causes organisms to disappear from the blood stream for several days, often to reappear a few days later. One study found that smears should be examined every four days over a minimum of three four day cycles<ref name="Ettinger>Ettinger, S.J, Feldman, E.C. (2005) Textbook of Veterinary Internal Medicine (6th edition, volume 2) W.B. Saunders Company</ref>, making it possible to have eight days between presentation and diagnosis. It also has the potential for misidentification of organisms.

The gold standard for diagnosis of Mhf infection is polymerase chain reaction (PCR), which detects the 16S RNA gene. The test is widely available through veterinary diagnostic laboratories. There are two types of PCR tests; conventional PCR which uses the presence or absence of bands on a gel to assess infection, and real-time PCR assays which uses fluoresence to mark a segment of DNA unique to the organism, making it highly sensitive and species-specific and thus the test of choice <ref name="Sykes"></ref>. Treatment with antimicrobials may result in false negatives on PCR so collecting before beginning therapy is preferable.

==Treatment==
The treatment of choice for Mhf infection is [[Tetracyclines|doxycycline]] for at least two weeks. Only cats who are anaemic and have clinical signs and laboratory results consistent with haemoplasmosis should be treated as the drug does not reliably eliminate the organism<ref name="Sykes"></ref>. For this reason a PCR-positive cat may not become negative despite treatment and therapy cannot be used to ensure blood donor cats are free from infection.

[[Fluoroquinolones|Enrofloxacin]] is also an effective treatment <ref name="Tasker">Tasker, S, Helps CR, Day MJ et al.(2004) Use of a Taqman PCR to determine the response to ''Mycoplasma haemofelis'' infection to antibiotic treatment. '''JMicrobiol Methods''' 56(1):63-71</ref> but is a second choice due to the risk of acute retinal damage in cats.

A [[:Category:Transfusion Medicine|blood transfusion]] may also be required in cases of severe anaemia.

Antimicrobial therapy and blood transfusions should be initiated before PCR results are known, as this may take several days. In cats testing negative for Mhf and failing to respond to therapy, alternative diagnoses should be considered.

The use of [[Steroids|glucocorticoids]] to suppress immune-mediated damage to erythrocytes has been suggested. However, as this treatment may cause reactivation of a latent infection it is recommended that they only be used in cats not responding to doxycycline and/or for whom there is no definitive diagnosis.

==Prognosis==
Prognosis for infected cats is related to the severity of the anaemia at presentation. If an animal survives the initial anaemia prognosis for clinical recovery is good. However, antibiotics do not clear the infection so many cats become carriers of the organism. Affected animals may also have intercurrent disease, such as retroviral infections, which will also affect the prognosis.

{{Learning
|flashcards = [[Small Animal Emergency and Critical Care Medicine Q&A 12]]
|literature search = [http://www.cabdirect.org/search.html?rowId=1&options1=AND&q1=%22Mycoplasma+haemofelis%22&occuring1=title&rowId=2&options2=OR&q2=%22Haemobartonella+felis%22&occuring2=title&rowId=3&options3=AND&q3=&occuring3=freetext&x=48&y=12&publishedstart=yyyy&publishedend=yyyy&calendarInput=yyyy-mm-dd&la=any&it=any&show=all ''Mycoplasma haemofelis'' publications]

[http://www.cabdirect.org/search.html?q=%28title%3A%28%22Infectious+Anaemia%22%29+OR+title%3A%28Haemobartonellosis%29+OR+title%3A%28%22Mycoplasma+haemofelis%22%29+OR+title%3A%28%22Haemobartonella+felis%22%29%29+AND+od%3A%28cats%29 Feline Infectious Anaemia publications]
|full text = [http://www.cabi.org/cabdirect/FullTextPDF/2009/20093115252.pdf ''' Diagnosis and management of Hemoplasma infections.''' Lappin, M. R.; The North American Veterinary Conference, Gainesville, USA, Small animal and exotics. Proceedings of the North American Veterinary Conference, Orlando, Florida, USA, 17-21 January, 2009, 2009, pp 655-656, 23 ref.]

[http://www.cabi.org/cabdirect/FullTextPDF/2007/20073119573.pdf ''' Bartonellosis and hemoplasmosis in dogs and cats: emerging issues.''' Lappin, M. R.; The North American Veterinary Conference, Gainesville, USA, Small animal and exotics. Proceedings of the North American Veterinary Conference, Volume 21, Orlando, Florida, USA, 2007, 2007, pp 629-631]
|Vetstream = [https://www.vetstream.com/felis/Content/Disease/dis60170 Feline infectious anemia]
}}

==References==
<references/>
==Extra references==
Merck & Co (2008) '''The Merck Veterinary Manual''' (Eighth Edition) ''Merial''

{{Rebekah Brown
|date = July 3, 2012 }}

{{OpenPages}}

[[Category:Anaemia]]
[[Category:Lymphoreticular and Haematopoietic Diseases - Cat]][[Category:Cat Bacteria]]
[[Category:Expert_Review - Small Animal]]

Feline Herpesvirus 1

2016-01-19T09:42:20Z

BaraStudent: /* References */

{{OpenPagesTop}}
== Introduction ==

Feline Herpes virus ('''FHV-1''') causes an upper respiratory tract infection: '''Feline Viral Rhinotracheitis'''.

Viruses and bacteria are involved in the complex, with the most frequent aetiologic agent being FHV-1, and less frequently [[Feline Calicivirus|feline calicivirus]] and/or ''[[Chlamydophila psittaci]]''. All three agents infect URT respiratory epithelium, although FHV-1 has the highest affinity for this epithelium. Feline calicivirus more frequently infects the oral mucosa -> ulcerative stomatitis and ''C. felis'' more frequently infects the conjunctival epithelium -> chronic conjunctivitis. All three together will result in the disease complex 'cat flu'.

Infection of the respiratory epithelium by FHV-1 results in a typical neutrophilic rhinitis with intraepithelial intranuclear eosinophilic inclusion bodies, with expected clinical signs. Resolution of these clinical signs usually occurs by 7-14 days, however, FHV-1 remains '''latent''' in the trigeminal ganglion, and can reactivate at times of stress. It can infect the cornea - ulcerative keratitis. FHV- 1 is the most common cause of keratitis and corneal ulcers in cats and gummy eyes in kittens.

Occasional mortality can occur in the kitten or immunocompromised animals usually associated with secondary bacterial infections.

The virus is widespread and common. It can cause serious infections as well as latent infections which can be reactivated on boarding or at other periods of stress.

== Clinical Signs ==

Upper respiratory tract signs such as [[rhinitis]], [[tracheitis]] and [[sinusitis]] as well as keratitis and [[Corneal Ulceration - Dogs and Cats|corneal ulcers]]. The corneal ulcers intially have a '''dendritic''' appearence, which is considered pathognomic. In combination with other agents, will cause 'cat flu' which will include sneezing, coughing, gummy eyes, nasal discharge, dyspnoea and conjunctivitis.

== Diagnosis ==

Clinical signs and history are usually used as a presumptive diagnosis prior to definitive diagnosis via laboratory tests.

'''Nasal swabs''' on first week of infection can be cultured for virus isolation, plus a swab of the eye.

== Treatment ==

For keratitis with corneal ulcers treat with subcutaneous omega interferon and give topical trifluorothymidine (thymidine analogue) on eyes.

== Control ==

Killed and live '''[[vaccines]]''' are available. Live vaccines have provoked symptoms in immunosuppressed kittens and are no longer used in the UK.

== References ==

Bridger, J and Ruseel, P, (2007) Virology Study Guide, Royal Veterinary College

Ettinger, S.J. and Feldman, E. C. (2000) Textbook of Veterinary Internal Medicine Diseases of the Dog and Cat Volume 2 (Fifth Edition), W.B. Saunders Company

Ettinger, S.J, Feldman, E.C. (2005) Textbook of Veterinary Internal Medicine (6th edition, volume 2), W.B. Saunders Company

Merck & Co (2008) The Merck Veterinary Manual (Eighth Edition), Merial

{{Learning
|powerpoints = [[E-Lecture:Feline Herpesvirus-1]]
|Vetstream = [https://www.vetstream.com/felis/Content/Disease/dis60212 Feline herpesvirus disease]
}}

{{review}}

{{OpenPages}}

[[Category:Herpesviridae]] [[Category:Expert_Review - Small Animal]] [[Category:Cat_Viruses]] [[Category:Respiratory_Diseases_-_Cat]] [[Category:Respiratory_Viral_Infections]]
[[Category:Hepatitis, Viral]]

Feline Immunodeficiency Virus

2016-01-19T09:40:29Z

BaraStudent:

{{OpenPagesTop}}
Also known as: '''''FIV

==Description==

Feline immunodeficiency virus is a retrovirus that causes immunodeficiency disease in the domestic cat.

==Agent==
FIV is a member of the [[Category:Lentiviruses|lentivirus]] genus of the [[:Category:Retroviridae|Retroviridae]] family. For general information about the family see [[Retroviridae Overview]].

FIV was first discovered in a cat rescue facility in the United States where cats had been showing similar clinical signs to people with acquired immunodeficiency syndrome2. Subsequently it has been shown that FIV has been present in the cat population since the late 1960s, and that the virus is very similar to the human retrovirus, HIV. However, despite these similarities, FIV is specific to cats, and people cannot become infected with the virus.

==Transmission and Epidemiology==
The major route of transmission is via saliva, particularly through biting2, 3. Therefore, those cats showing territorial aggression are most at risk of contracting FIV. High levels of virus are found in the saliva of infected cats, particularly those in the stages of acute or terminal infection3. Less commonly, salivary transmission can occur via shared food bowls and mutual grooming. Vertical transmission can occur, either transplacentally or via milk2, but venereal transmission has not been reported. The likelihood of infected kittens being born to a FIV-infected mother depends on the stage of infection: up to 70% of kittens are born infected if the queen suffers acute infection during pregnancy, but chronic infection of the mother rarely results in transplacental transmission4. The potential role of blood-sucking insects, such as fleas, in spreading infection is unknown2.

It is clearly possible that horizontal transmission can occur within multi-cat households, but in some households only a single cat in a group may be FIV positive, whereas in others nearly every cat may be infected. Overall it appears that if fighting among cats housed together is rare, the prevalence of FIV is likely to be low4.

FIV infection is prevalent worldwide, with between 1 and 14% of healthy cats and up to 44% of sick cats harboring the virus4.

==Pathogenesis==
The pathogenicity of FIV is strain dependent, and can vary widely. For all strains, feline lymphocytes and macrophages are the preferred cells for virus replication, and so FIV disrupts the function of the immune system. FIV gains entry to the cell via feline CD134, a surface molecule, and uses various chemokine receptors as secondary receptors5. In acute infection, the virus spreads from the site of entry to the lymphoid tissues and thymus, where it first infects T-lymphocytes and then macrophages. Although both CD4+ and CD8+ cells can be infected by FIV and lysed in culture, the virus appears to preferentially destroy CD4+ cells. This initially results in a change in the ratio of CD4+ to CD8+ cells, from roughly 2:1 to less than 1:15. After several months of infection, an absolute reduction in CD4+ is appreciable.

Approximately three weeks after infection, cats may show the "primary phase" of FIV infection with malaise, lymphadenopathy and pyrexia2. Viraemia peaks at 7-8 weeks and then declines, but increases again in the terminal stages of disease1. The host then remains asymptomatic for an indefinite period until cell-mediated immunity is disrupted by a decrease in the production of Th1 cytokines. In the advanced stages of infection, humoral immunity is also adversely affected. Although clinical signs are primarily due to changes related to T-cell populations, macrophages are the main reservoir of FIV in infected cats5. These cells are capable of transporting virus to various tissues of the body, and also suffer impairment of function, such as an increase in the production of TNF. Microglia and astrocytes in the brain, and megakaryocytes in the bone marrow, can become infected with FIV1, 5, and co-infection with [[Feline Leukaemia Virus|feline leukaemia virus]] can increase the expression of FIV in many tissues, including the kidneys, liver and brain.

==Signalment==
Feline immunodeficiency virus occurs frequently in cats throughout the world, and similar viruses have been recovered from wild and zoo felids1. FIV infection increases in prevalence in older cats, and the average age at diagnosis is 5 years5. Male cats are more commonly infected than females as they roam more and exhibit a higher degree of territorial aggression2, 3, 4, 5. There are no breed predilections5.

==Diagnosis==
The signs of feline immunodeficiency virus infection can be very variable, as signs are dependent on the secondary infections that become established. However, differential diagnoses for the immunosuppressive effects and some other primary effects of the virus include [[Feline Leukaemia Virus|feline leukaemia virus]] infection, [[Toxoplasmosis - Cat and Dog|toxoplasmosis]] and the [[Feline Infectious Peritonitis|dry form of FIP]]6. Primary bacterial, parasitic, viral or fungal infections should also be ruled out5.

===Clinical Signs===
The clinical signs in the immunosuppressive stage of the disease are related to secondary infections and are therefore extremely variable. Clinically, the associated conditions cannot be distinguished from those occurring in feline leukaemia virus-related immunosuppression. Patients often present with vague signs, such as inappetance or weight loss, and a history of recurrent minor illness related to the gastrointestinal or upper respiratory tract is common. Disease of the oral cavity including gingivitis and stomatitis is frequently seen. This can be linked to secondary pathogens such as [[Feline Calicivirus|calicivirus]] and oral bacteria. Calicivirus, along with other organisms such as [[Feline Herpesvirus 1|herpesvirus]], ''[[Toxoplasma gondii]]'' and ''Chlamydia psittaci'', can cause ocular signs including conjunctivitis, keratitis, uveitis and chorioretinitis in 35% of cases. Similar microbes give rise to secondary cat flu, and diarrhoea occurs in a quarter of affected cats. Other common signs due to immunosupression include anaemia (due to ''[[Haemobartonella felis]]''), meningoencephalitis, pneumonia, glomerulonephritis, renal failure, cystitis and pyoderma, caused by a variety of bacteria. The potentiating effects of FIV on FeLV infection can also induce neoplasia.

The virus itself may also have certain effects. Half of all cats affected display lymphomegaly, and pyrexia occurs in 30% of cases2. Anaemia, neutropenia, lymphopenia and thrombocytopenia are commonly seen, as well as diarrhoea and uveitis. Neurological signs, renal disease and neoplasia may also be direct effects of feline immunodeficiency virus.

===Laboratory Tests===
No typical changes for FIV infection are revealed by routine haematology and biochemsitry. The haemogram may be normal, or anaemia, lymphopenia or neutropenia can be seen, related to the direct effects of the virus. Secondary infection may result in a neutrophilia. Biochemical changes reflect the associated conditions in individual cases5.

Diagnosis of FIV is made by demonstrating the presence of antibodies against the virus. ELISA tests are available for in-house use, with some kits detecting antibody to the core protein p24 and others detecting antibody to the envelope protein gp4l2. Non-haemolysed plasma or serum is used for performing the in-house ELISA. Results must be interpreted with caution.

Once a cat acquires FIV infection, the antibodies created persist for life. This means that an '''[[ELISA]] test''' at any stage after infection should give a positive result. However, the test has a sensitivity of 98%, and so false positives do occur. Because of this, animals that test positive to an in-house ELISA, should be re-tested using a different test. Laboratories offer an '''immunoblot (Western blot)''' to confirm the diagnosis in cats that are ELISA-positive. The problem of using a test that detects antibodies becomes apparent when it is necessary to test kittens that are born to an FIV-positive queen. Antibodies against FIV are passively acquired via the milk, and can be detected when an ELISA test is used. This makes it impossible to distinguish animals that have been transplacentally infected with virus and are producing their own antibodies from those which have merely acquired pre-formed antibodies from their mother. Maternally derived antibodies can persist for up to 6 months2, and so animals testing positive before this age should be retested at 8-12 months old5.

Negative results can be true negatives. Alternatively, they may arise when the cat is infected with FIV but the antibodies produced are not detectable by the test used. Conversely, the cat may be infected but antibodies are not present, for example in the first two months of infection2. Therefore, if clinical signs give a strong suspicion of FIV infection, or the cat is known to be at risk (for example, recently bitten by and infected cat), animals should be retested 6-8 weeks later and use of an immunoblot should be considered. Up to 15% of cats completely fail to ever mount an antibody response against FIV infection. Virus isolation can be performed but is not widely available outwith the context of research4, 5. An RT-PCR tests is commercially available and detects virus rather than antibody with high specificity, but variations between strains and laboratories may make this test unreliable2, 4, 5.

===Pathology===
On post-mortem examination, there is lymphadenopathy. Intestinal lesions similar to those seen in feline panleukopenia virus infection may be apparent5.

In early disease, lymphadenopathy is seen histologically to be due to follicular hyperplasia and infiltration of plasmacytes to surround the cortex. Later in disease, a mixture of follicular hyperplasia and follicular depletion may exist, and in the terminal stages of FIV infection, follicular involution is the key feature5. Lymphoplasmacytic infiltrates are seen in the gingiva, lymphoid tissues, spleen, kidney, liver and brain. Brain lesions also include perivascular cuffing, gliosis, neuronal loss, vacuolation of the white matter and, occasionally, the presence of giant cells.

==Treatment==
In the sick FIV-positive cat, treatment is aimed at symptomatic and supportive care and management of the secondary infections present. Because these animals are immunosuppressed, their response to antibiotic therapy is often much slower and less successful2, 5. Therefore, much longer courses of antimicrobials are often required in FIV positive cats compared to normal animals. Higher doses may also be necessary4, 5. Antibiotics used should be broad spectrum, with activity against anaerobic bacteria. Combinations including metronidazole or clindamycin are therefore good choices5. In inflammatory conditions, such as gingivitis/stomatitis, careful use of anti-inflammatory doses of corticosteroids in combination with antibiosis may be effective in reducing the severity of disease2, 4, 5, 6. Topical steroids may be used in uveitis. Tooth extraction and scale and polishing can also help in the control of gingivitis. Dietary modifications may need to be made, for example in the face of renal disease or diarrhoea5, and appetite stimulants such as cyproheptidine can be useful in anorexic cats. Cats should not be fed raw meat and should be discouraged from hunting due to the increased risk of ''Toxoplasma gondii'' infection2. Griseofulvin is contraindicated in FIV-positive individuals because it can cause a severe neutropenia that can enhance the establishement of secondary infections5.

Preventative strategies should also be implemented in the FIV-infected animal in order to protect the cat from acquiring potentially life-threatening infections. This is particularly important as FIV positive animals are often refractory to treatment when secondary infections arise. Ideally, affected cats should be kept indoors to minimise exposure to potential pathogens4. Routine vaccination against herpesvirus, calicivirus and panleukopenia and possibly feline leukaemia virus is recommended2, and killed vaccines should be favoured as there is a small risk of the attenuated strains in modified live vaccines causing disease in the immunosuppressed patient2, 5. It may also be advisable to administer an extra booster before introducing the cat to a high risk environment, such as a cattery or in hospitalisation if the cat has not received one in the last six months2. Treatment against worms and fleas should be kept up to date, particularly to minimise the risk of transmission of ''Haemobartonella felis''.

Some antiviral agents have been shown to give improvement in FIV-infected cats2. Zidovudine is the mot effective of these5 but can induce bone marrow toxicity and so patients' haematological profile should be closely monitored2, 4, 5. Immunomodulatory products such as feline interferon omega also show some efficacy5. Bodyweight, haematocrit and neutrophil count improve with administration of oil of evening primrose2, particularly in asymptomatically or mildly affected FIV-positive cats.

==Control==
As the most significant mode of transmission of FIV is by biting, FIV positive animals should be neutered and, if possible, kept indoors to prevent onward spread of infection. At the very least, infected cats should be kept in at night, since this is when the majority of cat fights occur2. In multicat households, the other cats should be tested for FIV antibody. Positive cats can then be segregated or rehomed so that FIV-negative cats do not contract infection. However, if fighting seldom occurs within a household, the risk of horizontal transmission is low and so many owners elect to keep the household as it is. If this is the case, cats should be fed from separate bowls, and bowls, litter trays and other fomites should be routinely disinfected. FIV positive queens should not be used for breeding, and any kittens that do happen to be born from infected mothers should be hand-reared to minimise the risk of infection through milk2. Kittens should then be antibody tested after six months of age.

Although an inactivated whole-virus vaccine is available, its efficacy is highly variable and often low after three doses5. The vaccine is not available in the UK, and the WSAVA guidelines advise against its use as it can later prevent diagnosis of FIV associated disease by ELISA or immunoblot. One of the major obstacles to vaccine design is the massive genomic variability between FIV strains. It is unlikely that any effective FIV vaccine will appear on the market for several years2.

==Prognosis==
The long-term prognosis for FIV-infected cats is guarded, but some cats will survive for many years following diagnosis. A cat should therefore never be euthanased based on a positive test result for FIV4. Around 20% of affected cats die within the first two years after diagnosis; this equates to a 20% mortality rate in the first 4.5-6 years after the estimated time of infectionfmc. In general, the more chronic and severe the clinical signs, the worse the prognosis is. The duration of the asymptomatic period following FIV infection varies with the infecting strain and cannot be predicted. However, cats affected at a younger age are more likely to progress to an immunodeficient state4.

{{Learning
|literature search = [http://www.cabdirect.org/search.html?rowId=1&options1=AND&q1=title:(%22Feline+Immunodeficiency+Virus%22)+OR+(title:(FIV)+AND+od:(cats))&occuring1=freetext&rowId=2&options2=AND&q2=&occuring2=freetext&rowId=3&options3=AND&q3=&occuring3=freetext&publishedstart=2000&publishedend=yyyy&calendarInput=yyyy-mm-dd&la=any&it=any&show=all&x=69&y=12 Feline Immunodeficiency Virus publications since 2000]
|Vetstream = [https://www.vetstream.com/felis/Content/Disease/dis60143 Feline immunodeficiency virus disease - Felis]
}}

==Links==
*[http://www.fabcats.org/owners/fiv/info.html Feline Advisory Bureau FIV Factsheet]

==References==

#Wise, D J and Carter, G R (2005) ''' A Concise Review of Veterinary Virology''', ''IVIS''.
#Caney, S (2000) Feline immnunodeficiency virus: an update. ''In Practice'', '''22(5)''', 255-260.
#Johnson, C M (2005) Transmission of Feline Immunodeficiency Virus. ''Proceedings of the 56th Annual Meeting of the American College of Veterinary Pathologists and 40th Annual Meeting of the American Society for Veterinary Clinical Pathology''.
#The European Advisory Board on Cat Diseases (2008) Feline Immunodeficiency Virus. ''Guidelines of Feline infectious Diseases''.
#Tilley, L P and Smith, F W K (2004) '''The 5-minute Veterinary Consult (Fourth Edition)''',''Blackwell''.
#Rand, J (2006) '''Problem-based feline medicine''', ''Elsevier Health Sciences''.
#Merck & Co (2008) '''The Merck Veterinary Manual (Eight Edition)''', ''Merial''.
#Morrision, W B (2002) '''Cancer in dogs and cats: medical and surgical management''', ''Teton NewMedia''.

{{review}}

{{OpenPages}}

[[Category:Lentiviruses]][[Category:Cat Viruses]][[Category:Secondary Immunodeficiency]][[Category:Immunological Diseases - Cat]]
[[Category:Integumentary System - Viral Infections]]
[[Category:Expert Review]]

Feline Calicivirus

2016-01-19T09:37:15Z

BaraStudent:

{{OpenPagesTop}}
==Introduction==
[[Image:Feline Calcivirus.jpg|right|thumb|200px|Feline calicivirus infection in a cat, showing ulceration, secondary gingivitis, rhinitis, faucitis and hypersalivation. Source: Wikimedia Commons; Author: Kalumet (2005)]]
The normal hosts for this virus are domestic cats and cheetahs. The virus has a high morbidity/low mortality rate, but affected animals can be further compromised by concurrent infection.
The incubation period is 2-10 days.

Clinical signs include:
*Vesicles and ulcers of the oral epithelium (2-5mm)
*Nasal and ocular discharge
*Sneezing
*Anorexia
Variable signs include:
*Pyrexia
*Dyspnoea
*Conjunctivitis
*Rhinitis
*Tracheitis
*Pneumonia
Differential Diagnoses may include:
*[[Feline Herpesvirus 1]]
*''[[Chlamydophila felis]]''
*''[[Bordetella bronchiseptica]]''
Recovery can be followed by '''carrier status'''

==Epidemiology==
FCV is endemic worldwide. Transmission occurs through '''direct contact''' with secretions of carrier cats or '''indirect contact''' via drinking bowls, etc. Clinical disease is most frequently seen in kittens; '''active immunity''' is generally present in animals over 1 year of age. Antigenic variation means that subclinical reinfections can occur. Calicivirus is one of the agents of [[Feline Upper Respiratory Disease Complex|cat flu]].

==Antigenicity==
A single serotype has been identified which typically has antigenic variations.

Recent strains of the virus have been shown to cause systemic disease, where the initial upper respiratory signs are followed by:
*Severe pyrexia
*Oedema, particularly of the head and limbs
*Skin ulcers
*Icterus and Petchiae
The mortality rate of recently emerging strains can be as high as 50%, and higher in cats over 1 year of age. Conventional vaccinations are thought to be ineffective against these strains.

==Diagnosis==
Clinical signs are non specific with many other differentials. Nasal, conjunctival, or oropharyngeal swabs can be taken for virus isolation. Cytology of affected cells may demonstrate pyknosis (an irreversible condensation of chromatin in the cell nucleus undergoing necrosis or apoptosis) - feline herpes causes cellular swelling and syncytia formation.

==Control==
*Virulent isolate outbreak: quarantine and restrict movement of in contact animals.
*Prevention: Live or dead [[Vaccines|vaccines]] are available that contain broadly cross-reactive strains. [[Vaccines#Cat_Vaccinations|Vaccination]] is often given in combination with feline herpes and panleukopenia virus immunization.
The virus presents a particular concern for catteries due to the epidemiological risk of spread in intensively kept cats.

{{Learning
|flashcards = [[Feline Medicine Q&A 10]]
|literature search = [http://www.cabdirect.org/search.html?rowId=1&options1=AND&q1=feline+calicivirus&occuring1=title&rowId=2&options2=AND&q2=&occuring2=freetext&rowId=3&options3=AND&q3=&occuring3=freetext&x=41&y=14&publishedstart=yyyy&publishedend=yyyy&calendarInput=yyyy-mm-dd&la=any&it=any&show=all Feline Calicivirus publications]
|full text = [http://www.cabi.org/cabdirect/FullTextPDF/2007/20073085492.pdf '''Cats and calicivirus infection - the evolving pattern of disease.''' Radford, A.; Coyne, K. P.; Dawson, S.; Porter, C. J.; Gaskell, R. M.; Svoboda, M. ; Czech Small Animal Veterinary Association, Prague, Czech Republic, 2006 World Congress Proceedings. 31st World Small Animal Association Congress, 12th European Congress FECAVA, & 14th Czech Small Animal Veterinary Association Congress, Prague, Czech Republic, 11-14 October, 2006, 2006, pp 343-346, 26 ref.]
|Vetstream = [https://www.vetstream.com/felis/Content/Disease/dis60211 Feline Calicivirus disease - Felis]
}}

{{review}}

{{OpenPages}}

[[Category:Caliciviridae]][[Category:Cat Viruses]][[Category:Respiratory Diseases - Cat]]
[[Category:Expert Review]]
[[Category:Respiratory_Viral_Infections]]
[[Category:Other Oral Conditions]]

Ehrlichia canis

2016-01-19T09:35:21Z

BaraStudent:

===Canine monocytic ehrlichiosis===

*Generalised disease of dogs in tropical and subtropical regions
*Caused by ''Ehrlichia canis''
*The brown tick, ''Rhipicephalus sanguineus'', is the main vector
*Dogs may carry the organism for 2 years after resolution of clinical signs

*Clinical signs
**Incubation period of 3 weeks
**Acute, subclinical or chronic phases
**Acute phase: fever, thrombocytopenia, leukopenia and anaemia
**Subclinical phase: low blood cell numbers but minimal clinical signs; can progress to a severe disease, tropical canine pancytopenia
**Chronic phase: bone marrow depression, haemorrhages, neurological disease, peripheral oedema, emaciation and hypotensive shock

*Diagnosis
**''E. canis'' morulae present in mononuclear cells in Giemsa-stained blood smears
**Rising antibody titre detected by indirect immunofluorescence
**Culture in canine macrophages

*Treatment and control
**Doxycycline for 10 days
**Fluid therapy or blood transfusion
**Prophylactic tetracyclines

{{Learning 
|Vetstream = [https://www.vetstream.com/canis/Content/Disease/dis00999.asp Ehrlichiosis] [https://www.vetstream.com/canis/Content/Bug/bug00353.asp Rhipicephalus sanguineus] [https://www.vetstream.com/canis/Content/Factsheets/FactSheet075.asp Removing a tick factsheet]
|full text = [http://www.cabi.org/cabdirect/FullTextPDF/2009/20093115246.pdf ''' Update on canine ehrlichiosis/anaplasmosis and rocky mountain spotted fever.''' Birkenheuer, A.; The North American Veterinary Conference, Gainesville, USA, Small animal and exotics. Proceedings of the North American Veterinary Conference, Orlando, Florida, USA, 17-21 January, 2009, 2009, pp 639-640]

[http://www.cabi.org/cabdirect/FullTextPDF/2009/20093115234.pdf ''' Tick-borne disease testing: canine erhlichiosis and anaplasmosis.''' Alleman, R.; The North American Veterinary Conference, Gainesville, USA, Small animal and exotics. Proceedings of the North American Veterinary Conference, Orlando, Florida, USA, 17-21 January, 2009, 2009, pp 629-631]

[http://www.cabi.org/cabdirect/FullTextPDF/2007/20073161532.pdf ''' Recent concepts in diagnosis of canine ehrlichiosis.''' Bindu Lakshmanan; Lalitha John; Intas Pharmaceuticals Ltd, Ahmedabad, India, Intas Polivet, 2007, 8, 1, pp 124-127, 30 ref.]

[http://www.cabi.org/cabdirect/FullTextPDF/2006/20063221936.pdf ''' Canine ehrlichiosis - a review.''' Kafil Hussain; Soodan, J. S.; Neelesh Sharma; Upadhyay, S. R.; North-East Veterinarian, Guwahati, India, North-East Veterinarian, 2006, 6, 2, pp 18-20, 13 ref.]

[http://www.cabi.org/cabdirect/FullTextPDF/2009/20093115234.pdf '''Tick-borne disease testing: canine erhlichiosis and anaplasmosis.''' Alleman, R.; The North American Veterinary Conference, Gainesville, USA, Small animal and exotics. Proceedings of the North American Veterinary Conference, Orlando, Florida, USA, 17-21 January, 2009, 2009, pp 629-631]
 }}

[[Category:Rickettsiales]][[Category:Dog Bacteria]]
[[Category:To_Do_-_Bacteria]][[Category:Dermatological Diseases - Dog]]

Cryptococcosis

2016-01-19T09:31:23Z

BaraStudent:

*Over 19 species
**''[[Cryptococcus neoformans|Cryptococcus neoformans]]'' only major pathogen

*Worldwide

*Occurs in high concentrations in pigeon droppings (high creatinine concentration)
**The pigeon is not infected
**''C. neoformis'' colonise the droppings after they have been excreted
**Also found in fruit, milk and soil

*Exogenous, inhaled infection which is generally sporadic (non-contageous)
**Can also be absorbed via skin penetration and ingestion

*May be a primary pathogen or opportunistic

*Targets the [[Cardiorespiratory System Overview - Anatomy & Physiology|respiratory system]]
**Including the [[Paranasal Sinuses - Anatomy & Physiology|paranasal sinuses]]
**Also can be systemic, cutaneous, visceral, skeletal or ocular

*Causes sporadic mastitis in cattle
**Can spread within the herd

*Affects the [[Nervous and Special Senses - Anatomy & Physiology#Central Nervous System (CNS)|CNS]] of dogs and cats
**[[Paranasal Sinuses - Anatomy & Physiology|paranasal sinuses]] and [[Pharynx - Anatomy & Physiology|pharynx]] can be infected with dissemination to the [[Nervous and Special Senses - Anatomy & Physiology#Central Nervous System (CNS)|CNS]] and other tissues
***E.g. [[Lungs - Anatomy & Physiology|Lungs]], [[Urinary System Overview - Anatomy & Physiology#The Kidney|kidneys]] and [[Joints - Anatomy & Physiology|joints]]
**Also causes subcutaneous granulomas
**The tip of the nose is a common site of infection in cats
***See [[Respiratory Fungal Infections - Pathology#In Cats|here]]

*Causes myxoma-like lesions of the [[Lungs - Anatomy & Physiology|lung]] and [[Lips|lip]] in horses

*Causes cryptococcal meningitis in humans

*Also affects dolphins, foxes, ferrets, monkeys, birds, cheetahs and guinea-pigs

*Large yeast with capsule seen using India ink stain

*Stains with PAS (Periodic acis Schiff)

*Gram positive

*Grows on blood agar and Sabouraud's Dextrose agar forming white, granular colonies which become slimy, mucoid and turn creamy/brown within a week

*Species identified by carbohydrate assimilation tests

*Antigen and antibody should be tested for as [[Immunoglobulins|antibody]] formed by the body is soon overwhelmed and neutralised by abundent polysaccharide antigen from the capsule in active, systemic infections
**Latex agglutination for [[Adaptive Immune System - Overview#Actions of the Adaptive Immune System|antigen]], complement fixation, ELISA and IFAT can be used

{{Learning
|Vetstream = [https://www.vetstream.com/felis/Content/Disease/dis02453 Cryptococcosis - Felis]
|flashcards = [[Yeast-like_Fungi_-_Flashcards#Cryptococcosis|Cryptococcosis Flashcards]]
}}

[[Category:Respiratory Fungal Infections]]

Chlamydophila felis

2016-01-19T09:27:04Z

BaraStudent:

{{OpenPagesTop}}
Also know ans: '''''Chlamydiosis - Chlamydia psittaci (felis)'''''

== Introduction ==
''Chlamydophila felis'' causes a persistent respiratory infection. It usually occurs along with [[Feline Herpesvirus 1|Feline Herpesvirus]] and [[Feline Calicivirus]] to form the disease complex 'cat flu'. Signs include mild conjunctivitis, serous purulent [[Rhinitis|rhinitis]] and conjunctivitis and in severe cases mild [[Bronchointerstitial Pneumonia|bronchointerstitial pneumonia]].

Up to 10% of cats are affected, or have been affected with this bacterial infection. Transmission will occur via direct contact with conjunctival or nasal secretions. The infection may persist with prolonged shedding and clinical relapses. The stress of parturition and lactation may cause shedding of organisms leading to transmission to offspring.

== Clinical Signs ==

The incubation period is 5 days, after which one will see conjunctival congestion, clear ocular discharge, blepharospasm, sneezing and nasal discharge. If this infection is part of the 'cat flu' complex, one will also see rhinitis and ulcers of the eyes and oral cavity. The infection resolves within a few weeks, or causes persistent infection.

== Diagnosis ==
Clinical signs, especially if 'cat flu' symptoms, are indicative of the disease. Smears from the conjunctiva should be taken and stained for microscopy. Intracytoplasmic inclusions should be seen. Occular and nasal secretions should also be taken so that antigen detection by [[ELISA testing|ELISA]], PCR, Kosters and [[Immunofluorescence|fluorescent antibody test]] can be performed.

== Treatment and Control ==

Modified live vaccines reduce clinical signs but do not prevent infection or shedding.

Treatment is supportive, including cleaning sore eyes, blending food into liquid form and cleaning the cats nose regularly. To encourage the cat to eat, extra smelly food should be given as the cat will be nasally congested so cannot smell very well. Things like fish or meat stock should also be put into water to encourage the cat to drink.

== References ==

Bridger, J and Russell, P (2007) Virology Study Guide, Royal Veterinary College

Ettinger, S.J. and Feldman, E. C. (2000) Textbook of Veterinary Internal Medicine Diseases of the Dog and Cat Volume 2 (Fifth Edition), W.B. Saunders Company

Merck & Co (2008) The Merck Veterinary Manual (Eighth Edition), Merial

{{Learning
|Vetstream = [https://www.vetstream.com/felis/Content/Disease/dis60168 Chlamydia disease - Felis]
}}

{{review}}

{{OpenPages}}
[[Category:Chlamydophila_species]] [[Category:Respiratory_Bacterial_Infections]] [[Category:Cat_Bacteria]] [[Category:Respiratory_Diseases_-_Cat]] [[Category:Expert_Review]]

Aspergillosis

2016-01-19T09:22:20Z

BaraStudent: /* Birds */

{{OpenPagesTop}}
Also known as: '''''Brooder Pneumonia in young birds'''''

== Introduction ==
Apergillosis is a disease of the respiratory system caused by several ''[[Aspergillus spp.]]''. ''Aspergillus fumigatus'' is the most frequently encountered species in domestic animals but ''Aspergillus tereus'' and ''Aspergillus flavus'' have also been reported. ''Aspergillus'' is a ubiquitous saprophyte and is found worldwide. It is also a component of normal hair, skin and mucosal flora in both humans and animals. Commonly affected species include birds, dogs, cats, horses and cattle but the disease has been reported in many other wild and domestic species.

== Pathogenesis ==
In '''dogs''', spores are inhaled from the environment leading to fungal colonisation of the nasal cavities. Following their deposition in tissue and recognition by phagocytes, an inflammatory response is triggered. Haemolytic and dermonecrotic toxins as well as fungal protease and elastase are released leading to tissue damage.

In '''horses''', the pathogenesis of [[Guttural Pouch Mycosis|'''guttural pouch mycosis''']] is largely unknown but is thought to relate to damage to the mucosal layer of the pouches by trauma or infection. This enables opportunistic ''Aspergillus'' fungi to invade and colonise the damaged tissue.

== Clinical Signs ==
=== Dogs ===
Aspergillosis is a common cause of nasal disease in dogs. Cases occur most commonly in young to middle-aged male dogs, but there is no apparent age or sex predilection. A higher prevalence of disease has been reported in '''doliocephalic breeds''' and '''outdoor/farm dogs'''. Clinical signs are those seen with any chronic nasal disease and include sneezing, unilateral or bilateral serosanguinous nasal discharge, ulceration of the nares, nasal pain and epistaxis. Neurological signs may be displayed if there is involvement of the cribriform plate.

The disease is usually localised to the paranasal sinuses and nasal cavity but a disseminated form with granulomas and infarcts has been reported, particularly in German Shepherds. This form of disease often involves multiple organ systems including the spleen and kidneys. Clinical signs include lethargy, anorexia, urinary incontinence and haematuria. The vertebrae are frequently affected and osteomyelitis and discospondlylitis are common features. Dermatological signs of disseminated aspergillosis include abscesses, draining tracts, oral ulcers and cutaneous nodules.

=== Horses ===
In the horse, ''Aspergillus'' most commonly affects the guttural pouches but infection may also lead to abortion, keratomycosis and rarely pulmonary aspergillosis. There is no age, sex or breed predisposition for guttural pouch mycosis and both left and right pouches are affected with equal frequency. Guttural pouch mycosis is characterised by spontaneous epistaxis (often in a resting horse) as a result of fungal erosion of the internal carotid artery. Other clinical signs include nasal discharge and dysphagia. Mycotic plaques are usually located on the caudodorsal aspect of the medial guttural pouch.

=== Cattle ===
Aspergillosis has a number of clinical manifestations in the cow including mastitis, placentitis, diarrhoea, ocular infection and mycotic pneumonia. Abortion in the second or third trimester of pregnancy has also been described. In the case of pulmonic disease, clinical signs may include pyrexia, cough, dyspnoea and tachypnoea but may be limited to vague signs such as weight loss or signs of mild respiratory disease. In aborting cattle, the foetus and placenta are retained and foetal lesions such as bronchopneumonia and dermatitis may be seen. Mastitic cows may display depression, weight loss and pyrexia with purulent mammary secretions and a hot, swollen udder.

=== Birds ===
Three forms of the disease have been reported in avian species; a diffuse infection of the air sacs; a diffuse pneumonic form and a nodular form involving the lungs. In chicks and poults the disease is known as ''''brooder pneumonia'''' and may affect many birds in a flock. It is a very common disease, especially in pet birds due to the poor environments in which the birds are kept, combined with the anatomy of their respiratory system. Animals become infected due to inhalation of spores from contaminated feed or litter. These spores remain lodged in the respiratory system without causing clinical disease until the bird is stressed. Disease normally occurs in the syrinx or the air sacs. Clinical signs include dyspnoea, diarrhoea, listlessness, pyrexia, loss of appetite and loss of condition. Seizures and torticollis may occasionally occur if infection disseminates to the brain. Eggs may also be infected, with the fungal infection growing in the air cell of the membrane within the egg. Embryos may die before hatching or be weak and dyspnoeic after hatching. Occasionally, nervous system problems or diarrhoea are found in birds that survive to hatch.

== Diagnosis ==
=== Dogs ===
'''Radiology''' is often performed in the diagnostic work up of an animal with suspected Aspergillosis. It should always be performed prior to other procedures such as rhinoscopy and biopsy in order to prevent haemorrhage that may obscure subtle radiographic findings. Open-mouth ventro-dorsal views often reveal generalised radiolucency and lysis of the turbinate bones. Additionally, '''cytological examination of aspirates''' often reveals presence of fungal hyphae with granulomatous to suppurative inflammation and necrosis. '''Rhinoscopy''' may also be used to directly visualise the lesions, revealing characteristic white-green fungal plaques and destruction of the nasal turbinates. It also allows collection of material for '''fungal culture'''. This may be achieved using Sabouraud's dextrose agar in order to demonstrate the organism but should not be used as the sole means of diagnosis due to the ubiquitous nature of ''Aspergillus'' in the environment. White colonies form initially which turn dark green, flat and velvet-like in appearance. '''Serological''' findings such as immunoelectophoresis, [[ELISA testing|ELISA]] and agar gel [[Immunodiffusion|diffusion]] may provide additional diagnostic information.

=== Horses ===
Diagnosis is obtained following '''endoscopic examination''' of the guttural pouches and observation of white-yellow-black mycotic plaques on the mucosal surface of the guttural pouches. Care must be taken whilst performing endoscopy due to the risk of dislodgement of a thrombus on the affected artery.

=== Birds ===
'''Endoscopy''' allows visualisation of the fungus and is the fastest and simplest way to obtain a tentative diagnosis. '''Culture''' of the lesions is required for definitive diagnosis. Post-mortem findings include bronchial or tracheal plugs, air cell plaques or small yellow nodules in the lungs. When ''Aspergillus'' infection is suspected in the embryo positive culture of lesions on the air cell membrane, lungs, air sacs or air passages is required for definitive diagnosis.

== Treatment ==
=== Dogs ===
Several different treatment options are available.

Ketoconazole can be administered '''orally''' for 6-8 weeks. Itraconazole has also been used. This can be effective in up to 50% of cases.

Another non-invasive option includes '''infusion''' of enilconazole or clotrimazole into the '''external nares''' whilst occluding the nasopharynx. The animal is first placed in dorsal recumbency, then switched to ventral recumbency and any fluid is allowed to drain from the nose. This technique may not be effective and may lead to aspiration pneumonia or oesophagitis from leakage of the agent.

The treatment of choice is topical application of the anti-fungal agent Clotrimazole. It is administered for one hour under general anaesthetic via indwelling '''catheters placed in the frontal sinus'''. Several treatments may be required. For cases that are non-responsive to Clotrimazole, treatment with Enilconazole may be attempted but this is associated with a higher complication rate.

=== Horses ===
Trans-arterial coil embolisation under fluoroscopic guidance is performed in order to cause internal occlusion of the affected arteries. Following arterial occlusion the mycotic plaques usually resolve without necessitating further treatment.

=== Cattle ===
Antifungal agents are currently unlicensed and management of the disease usually relies on preventative measures such as ensuring clean bedding and good husbandry.

=== Birds ===
Birds should be treated with both anti-fungal drugs and F10 disinfectant, delivered via nebulisation. This treatment should continue for a minimum of 6 weeks up to a period of 6 months, therefore cost considerations may need to be discussed with the owners. Following the cessation of treatment, repeat endoscopy should be performed to ensure the disease has resolved. Aspergillosis of the syrinx may present as an emergency due to obstruction of the airway. This requires surgical removal of the fungal growths. An air sac tube may be placed to stabilise the bird prior to the planned surgery, and endoscopy should be performed on the lungs and air sacs to assess the spread of the fungus and provide a prognosis (poor with further spread) before surgery is performed. A low dust level, high quality feed and frequent F10 fogging can help to prevent the disease. There is currently no recommended treatment for eggs infected with aspergillosis, therefore efforts should be concentrated on prevention. This is especially important in air-forced incubators, where aspergillosis can be a serious problem. Incubators and hatchers should be cleaned and fumigated between batches of eggs, and an 'all in, all out' system should be in operation. UV sterilization of eggs prior to incubation and sanitizing dips or washes may be used to reduce the chances of infection. Eggs should be examined for cracks and weighed at regular intervals, and dead eggs should be removed immediately as infection of viable eggs by dead ''Aspergillus''-infected eggs can occur. Also, eggs from damp or wet nests should not be incubated.

{{Learning
|flashcards = [[Systemic Mycoses - Flashcards#Aspergillosis|Aspergillosis Flashcards]]
[[Cytology Q&A 12]]

[[Small Animal Soft Tissue Surgery Q&A 11]]
|literature search = [http://www.cabdirect.org/search.html?q=title:(Aspergillosis)+AND+od:(cats) Aspergillosis in cats publications] [http://www.cabdirect.org/search.html?q=title:(Aspergillosis)+AND+od:(horses) Aspergillosis in horses publications] [http://www.cabdirect.org/search.html?q=title:(Aspergillosis)+AND+od:(cattle) Aspergillosis in cattle publications] [http://www.cabdirect.org/search.html?q=title:(Aspergillosis)+AND+od:(birds) Aspergillosis in birds publications] [http://www.cabdirect.org/search.html?q=title:(Aspergillosis)+AND+od:(sheep) Aspergillosis in sheep publications] [http://www.cabdirect.org/search.html?q=title:(Aspergillosis)+AND+od:(goats) Aspergillosis in goats publications] [http://www.cabdirect.org/search.html?q=title:(Aspergillosis)+AND+od:(pigs) Aspergillosis in pigs publications] 
|full text = [http://www.cabi.org/cabdirect/FullTextPDF/2007/20073017469.pdf '''Aspergillosis: a sapromycotic zoonosis.''' Mahendra Pal; Pratibha Dave; Intas Pharmaceuticals Ltd, Ahmedabad, India, Intas Polivet, 2006, 7, 2, pp 421-428, 44 ref.]
|Vetstream = [https://www.vetstream.com/felis/Content/Disease/dis02452 Aspergillosis - Felis]
}}

<gallery>

Image:Aspergillus sporing heads.jpg|<center>'''Aspergillus sporing heads'''Copyright Professor Andrew N. Rycroft, BSc, PHD, C. Biol.F.I.Biol., FRCPath</center>
Image:Mycelium aspergillus quink.jpg|<center>'''Aspergillus mycelium stained with blue/black Quink'''Copyright Professor Andrew N. Rycroft, BSc, PHD, C. Biol.F.I.Biol., FRCPath</center>
Image:Mycotic abortion asper 1.jpg|<center>'''Mycotic Abortion caused by Aspergillus'''Copyright Professor Andrew N. Rycroft, BSc, PHD, C. Biol.F.I.Biol., FRCPath</center>
Image:Mycotic abortion asper 2.jpg|<center>'''Mycotic Abortion caused by Aspergillus'''Copyright Professor Andrew N. Rycroft, BSc, PHD, C. Biol.F.I.Biol., FRCPath</center>
Image:Mycotic abortion asper 3.jpg|<center>'''Mycotic Abortion caused by Aspergillus'''Copyright Professor Andrew N. Rycroft, BSc, PHD, C. Biol.F.I.Biol., FRCPath</center>
Image:Nasal Aspergillus.jpg|<center>'''Nasal Aspergillus'''Copyright Professor Andrew N. Rycroft, BSc, PHD, C. Biol.F.I.Biol., FRCPath</center>
Image:Aspergillus in vivo.jpg|<center>'''''Aspergillus'' in vivo'''Copyright Professor Andrew Rycroft, BSc, PHD, C. Biol.F.I.Biol., FRCPath</center>
Image:Aspergillus swan.jpg|<center>'''''Aspergillus'' in a swan'''Copyright Professor Andrew N. Rycroft, BSc, PHD, C. Biol.F.I.Biol., FRCPath</center>
</gallery>

== References ==
*Barr, S. C., Bowman, D. D. (2006) '''The 5-minute Veterinary Consult Clinical Companion: canine and feline infectious diseases and parasitology''' ''Wiley-Blackwell''
*Brown, SA & Rosenthal KL (1997) '''Self-Assessment Colour Review Small Mammals''' ''Manson Publishing Ltd''
*Carter, G. R., Wise, D. J. (2004) '''Essentials of Veterinary Bacteriology and Mycology''' ''Wiley-Blackwell''
*Ettinger, S. J. (2000) '''Pocket Companion to Textbook of Veterinary Internal Medicine''' ''Elsevier Health Sciences''
*Muller, G. H., Scott, D. W., Kirk, R. W., Miller, W. H., Griffin, C. E. (2001) '''Muller and Kirk's Small Animal Dermatology''' ''Elsevier Health Sciences''
*Stanford, M (2009) '''Respiratory Disease in Birds''' RVC Intergrated BVetMed Course, ''Royal Veterinary College''

{{review}}

{{OpenPages}}

[[Category:Respiratory_Fungal_Infections]] [[Category:Respiratory_Diseases_-_Dog]] [[Category:Respiratory_Diseases_-_Birds]] [[Category:Expert_Review]][[Category:Respiratory_Diseases_-_Cattle]] [[Category:Respiratory_Diseases_-_Horse]]
[[Category:Expert Review]]

Diarrhoea – Rabbit

2015-08-25T18:25:42Z

BaraStudent: /* Acute diarrhoea of the young, newly acquired rabbit */

==“Diarrhoea syndromes”==
It is important to assess the material being produced that gives rise to the above title! See assessment of faeces below. It is amazing how many veterinarians confuse polyuria in rabbits with diarrhoea. Owners often confuse the occurrence of uneaten caecotrophs with diarrhoea in their pets. It’s better to react to variation in the nature and production of faeces and consider such clinical entities as [[Clagged Vent – Rabbit|clagged vent]] – the passage of copious amounts of caecal material from the anus. This may be found adhered to the vent area. The caecotrophs may not been ingested because of non-gastro-intestinal causes (dental overgrowth, spinal deformities, etc).

“Diarrhoea” is rare in pet rabbits, especially adult ones and may result from enteritis which occurs in decreased gastrointestinal motility (constipation). So the appearance of the fluid stool of the carnivore with diarrhoea may not be seen in the similarly afflicted rabbit. In fact, the production of large masses of solid faeces is a more usual presentation, adhered to the vent and not removed by the animal.

If there are normal hard faecal pellets in the animal’s environment, the condition is not diarrhoea.

{| border="2" align="center" cellspacing="0" cellpadding="4" rules="all"; border-collapse:collapse;empty-cells:show"
|+
!bgcolor="#FFCC99"|
!bgcolor="#FFCC99"| Uneaten caecotrophs
!bgcolor="#FFCC99"| Diarrhoea
|-
|bgcolor="#FFFFCC"| Life threatening?
|bgcolor="#FFFFCC"| No
|bgcolor="#FFFFCC"| Yes, due to fluid and electrolyte disturbances
|-
|bgcolor="#FFFFCC"| Frequency of production
|bgcolor="#FFFFCC"| Once or twice a day
|bgcolor="#FFFFCC"| Several times a day, often mixed with mucus
|-
|bgcolor="#FFFFCC"| Hard faeces?
|bgcolor="#FFFFCC"| Yes - often normal production
|bgcolor="#FFFFCC"| No, only unformed stools seen
|-
|bgcolor="#FFFFCC"| Anorexia
|bgcolor="#FFFFCC"| No
|bgcolor="#FFFFCC"| Yes
|-
|bgcolor="#FFFFCC"| Depression
|bgcolor="#FFFFCC"| No
|bgcolor="#FFFFCC"| Yes
|-
|bgcolor="#FFFFCC"| Smell
|bgcolor="#FFFFCC"| Strong - risk of fly strike
|bgcolor="#FFFFCC"| Variable
|-
|bgcolor="#FFFFCC"| Owner reaction
|bgcolor="#FFFFCC"| Maybe over-react, due to smell
|bgcolor="#FFFFCC"| Probably slow, due to comparison with monogastric species.
|-
|}

==Acute diarrhoea of the young, newly acquired rabbit==
This is associated with dysbiosis of the caecum and may be compounded with installation of, for example, ''E. coli, Clostridia, Salmonella, Yersinia'' spp.

Treatment with appropriate antibiotic (administered parenterally), fluids, antispamodics, analgesics, warmth.

In young specimens, especially at or soon after weaning, the subject is usually found depressed often to the point of coma with slightly cyanosed extremities (due to the fur this may be visible only in the ears, on the muzzle, and around the vent). The doe is usually perfectly normal. Muco-gelatinous faeces are frequently observed in which significant levels of coccidial oocysts or nematode eggs may or may not be found. The strong likelihood of the presence of the ubiquitous ''Pasteurella multocida'' together with the poorly developed and compromised immune system of the juvenile animal must be consid¬ered and the owner given a poor prognosis.

These animals are usually badly dehydrated so the subject is immediately hospitalised in a warm cage (no higher than 25°C under an overhead infra-red lamp) and 50 – 100 ml warm Hartmann's Fluid are administered by intraperitoneal injection together with suitable antibiotic cover (in the absence of antibiotic sensitivities, I use metronidazole (an unauthorised product, a 0.5% infusion, is available from Millpledge) and hyoscine/dipyrone (Buscopan Compositum; Boehringer Ingleheim). Care should be taken not to mix these analgesics with NSAID's for fear of toxicity but other analgesics (opioids) may be used instead. The danger of using hyoscine is that there could be some intestinal immotility which could lead to more absorption of toxins from the gut. Consideration should be given to the use of xylazine as a visceral analgesic. Parenteral oxytetracycline (Engemycin 5%; Intervet) 72 hrs should be given to cover against endemic pasteurellosis and can be used simultaneously with metronidazole.

The animal is kept in the warm environment until recovery is clinically evident. Hydration is maintained (at least 50 ml/kg daily in divided doses, of either warmed Hartmann's Solution intraperitoneally or a solution of Liquid Lectade® (Pfizer) diluted 1:11.5 in potable water and administered by stomach tube). Probiotics (I use Avipro made by Vetark, in spite of little evidence in the literature that Lactobacillus is a commensal of the normal rabbit caecum) are useful because the rabbits often appreciate the taste and thereby take in adequate amounts of oral fluids. The use of antimicrobials and intensive care (fluids etc) may be extended for up to four days at the clinician's discretion (or the client's direction which is often based on economic exigencies) but if there is going to be any improvement it will usually occur within the first twenty-four hours.

The prognosis for this syndrome must be very guarded especially if clostridial entertoxaemia or viral, enteric infections or protozoal infestations are involved. Microbiological examination of faeces will help to identify the secondary infections, but the urgency of the case, especially as it frequently presents in the newly acquired pet, often precludes such procedures. Spirochaetes have been incriminated in one outbreak of fatal enteritis in a colony of young rabbits (Tribe et al 1989). Readers will be aware that the growth of Clostridium species requires anaerobic conditions (Carman et al 1983).

{{Learning
|flashcards = [[Rabbit Medicine and Surgery Q&A 07]]
|Vetstream = [https://staging.vetstream.com/lapis/Content/Freeform/fre00445 Diarrhea: overview]
}}

==References==
*Carman et al (1983) Laboratory diagnosis of Clostridium spiroforme-mediated diarrhoea (iota-enterotoxaemia) of rabbits. Veterinary Record, 113.
*Tribe G.W. et al (1989) Fatal enteritis in rabbits associated with a spirochaete. Veterinary Record 124, 595.
[[Category:Rabbit Digestion]]

Caecal Impaction – Rabbit

2015-08-25T18:23:10Z

BaraStudent:

Caecal impaction occurs in many syndromes in rabbits and can be difficult to assess. Harcourt Brown describes three distinct conditions: Caecal impaction, Dysautonomia and Mucoid enteropathy, the last two being described by other authors (eg. Whitwell) as the single condition, [[Constipative Mucoid Enteropathy – Rabbit|Constipative Mucoid Enteropathy (CME)]].

A rabbit with caecal impaction is inappetant and shows weight loss, although does not otherwise appear particularly unwell. The onset of clinical signs is insidious. Faecal output is reduced or absent and there may be mucus production. The impacted caecum is easily detected by gentle abdominal palpation. The caecum may dilate in later stages and this is seen on plain radiography.

Treatment is aimed at softening the impacted material (aggressive fluid therapy: IV SC IP and oral) and liquid paraffin may be administered by naso-oesophageal tube. COX-sparing NSAIDs are indicated (prostaglandin action is required on the fusus coli). Harcourt Brown (2002) describes the use of dinoprost.

Dysautonomia/[[Constipative Mucoid Enteropathy – Rabbit|Constipative Mucoid Enteropathy (CME)]] is more commonly encountered in weanling rabbits whereas simple caecal impaction is more common in adult pets.

{{Learning
|Vetstream = [https://staging.vetstream.com/lapis/Content/Freeform/fre00441 Cecum impaction]
}}

==References==
*Harcourt Brown, F. (2002) '''Textbook of Rabbit Medicine''', published by Butterworth Heinemann, Oxford. ISBN 0 7506 4002 2
*Whitwell, K. E. (1997) Mucoid Enteropathy: A new perspective. Procs Rabbit Welfare Fund Conference Watford

{{unfinished}}
[[Category:Rabbit Digestion]][[Category:To Do - Exotics]][[Category:To Do - Medium]]

Tyzzer's Disease - Rabbit

2015-08-25T18:21:43Z

BaraStudent:

Also known as: '''''Bacillary Typhilitis

Tyzzer's disease is caused by the obligatory intracellular [[Clostridium piliforme|''Clostridium (formerly Bacillus) piliformis'']], a gram-variable organism diagnosed on post-mortem examination by histopathology utilising Giemsa or Warthin-Starry staining techniques (Walden 1990). The organism may be seen on impression smears of the ileum lining (see Okerman 1994). The organism does not grow on broth or agar. Predisposing causes in rabbits are not known (Carman 1994) but weanlings are most frequently affected.

Symptoms include acute depression, watery diarrhoea and a high mortality rate) or chronic weight loss. Post-mortem findings include dehydration, oedema of the intestinal wall, necrosis of the colonic and caecal mucosa, and occasionally many necrotic foci in the liver.

Treatment is not generally recommended but may be attempted (tetracyclines). The disease has also been reported under circumstances which suggested that it may be spread by wild mice (MAFF monthly report 080892).

{{Learning
|literature search = [http://www.cabdirect.org/search.html?q=%28title%3A%28%22Tyzzer%27s+disease%22%29+OR+title%3A%28%22Bacillary+Typhilitis%22%29+OR+title%3A%28%22Bacillus+piliformis%22%29+OR+title%3A%28%22Clostridium+piliforme%22%29%29+AND+od%3A%28rabbits%29 Tyzzer's disease/''Clostridium piliforme'' in rabbits]
|Vetstream = [https://staging.vetstream.com/lapis/Content/Freeform/fre00077 Tyzzer's disease]
}}

{{unfinished}}
[[Category:To Do - Exotics]][[Category:To Do - Medium]]
[[Category:Enteropathies_-_Rabbit]]

Clagged Vent – Rabbit

2015-08-25T18:07:46Z

BaraStudent: /* Treatment of conditions involving uneaten caecotrophs */

Also known as '''''Un-ingested caecotrophs
==Causes of Clagged Vent==
===Reduced appetite for caecotrophs===
*High protein diet
*Low fibre diet
*Ad libitum feeding
*Taints
**plants altering odour

===Illness===
*Physically unable to reach or groom perineum
**Musculoskeletal problems
**Neurological disease (eg. ''E. cuniculi'')
**Spondylitis/kyphosis/arthritis
**Abdominal masses
**Large dewlap

===Pain associated with ingestion of caecotrophs===
*Urine scalding
*Dermatitis
*Infected perineal skin folds
*Dental disease

===Husbandry===
*Small cage
*Obesity
*Elizabethan collar
*Fluffy coat
*Interruption of daily routine, eg:
**feeding times
**photoperiod
*Stress
*Change of diet

==Treatment of conditions involving uneaten caecotrophs==
Rabbits stop eating their caecotrophs (probably because of the excess of dietary protein but the animals may be unable or unwilling to groom because they have overgrown teeth with sore mouths or tongues). Harcourt Brown (2002) differentiates between conditions in which the caecotrophs are normal or soft and lists different causes of the two conditions. This is not diarrhoea (although owners often mistake it as such. As caecotrophs are so sticky there is quite an accumulation of matter at the vent on which the rabbit then sits, thereby impacting the matter onto the surrounding tissues. The presenting clinical signs may include blow-fly myiasis.

The treatment is to lower the energy and protein content of the diet and to feed higher amounts of fibre (hay and straw). Restrict pellets to 10-20 gram per kg (20 g in fat rabbits for fear they become acetonaemic). You often have to be very strict with owners, as in the treatment of canine obesity. Antibiotics may have very little use in the treatment of these animals but concomitant infections (eg respiratory diseases) may have to be addressed, in which case I recommend oxytetracycline S/C q 72hrs (Engemycin 5%; Intervet). To stimulate the resumption of gut motility the use of cisapride (Prepulsid;Janssen Cilag) 6-8hrs is recommended but may be difficult to obtain so metoclopramide may be used instead - PO q12h. Ranitidine (PO q12h) is mentioned as a substitute for cisapride.

{{Learning
|flashcards = [[Rabbit Medicine and Surgery Q&A 07]]
|Vetstream = [https://staging.vetstream.com/lapis/Content/Freeform/fre00041 Sticky bottom syndrome]
}}

==References==
*Harcourt Brown, F. (2002) '''Textbook of Rabbit Medicine''', published by Butterworth Heinemann Oxford, ISBN 0 7506 4002 2

[[Category:Rabbit Digestion]]

Salmonellosis - Rabbit

2015-08-25T18:06:10Z

BaraStudent:

Salmonellosis is due to ''Salmonella typhimurium'' which has been recorded as manifesting a severe enteritis in baby rabbits. Clinical signs include depression, fever, +/- diarrhoea, abortion (Okerman 1994). Salmonellosis is a zoonosis.

[[Enterotoxaemia Treatment - Rabbit|Synopsis of treatment for enterotoxaemia and bacterial enteritis]]

{{Learning
|Vetstream = [https://staging.vetstream.com/lapis/Content/Freeform/fre00325 Salmonellosis in rabbits]
}}

{{unfinished}}
[[Category:Enteropathies_-_Rabbit]]
[[Category:To Do - Exotics]][[Category:To Do - Medium]]

Nematode Infestation – Rabbit

2015-08-25T18:04:56Z

BaraStudent: /* References */

==Introduction==
Nematode infestations are extremely uncommon in pet rabbits.

The stomach worm, ''Graphidium strigosum'', may cause ulceration and gastric perforation in wild rabbits and in pets, but are extremely rare in my experience.

==Clinical signs==
They include loss of weight and even death (Okerman 1988). The worms are red and measure 1-2 cm and are found on the mucosa of the stomach (Okerman 1994).

The intestinal worm, ''Trichstrongylus retortaeformis'', which may cause irritation of the small intestine arises when greens or grass are fed. Okerman records this as occurring very rarely in animals kept on wire mesh (1988).

The caecal worm, ''Passalurus ambiguus'', is quite common and is apparently harmless, but can give rise to anal irritation (even to the extent of rectal prolapse) and lack of thrift. It is usually diagnosed coincidentally on examination of faeces for other purposes. However Gentz et al (1995) state that clinical signs of passaluriasis include decreased weight gain, diminished activity, constipation, impaction or intussusception. They also state that the use of a sellotape strip to attempt to harvest eggs from around the anus (as described in oder references) is counter-productive as the rabbit pinworm does not deposit eggs around the anus.

==Treatment==
Treatment for all nematodes in pet rabbits includes the oral use of piperazine adipate (daily for two days), fenbendazole (once only Panacur®; Intervet). Hillyer (1994) quotes Patton and states that ivermectin is ineffective against passaluriasis

==References==
*Gentz, E. J. et al. (1995) Dealing with gastrointestinal, genitourinary and musculoskeletal problems in rabbits: Veterinary Medicine 90 (4) 365-372
*Hillyer, E. V. (1994) '''Pet Rabbits'''. Veterinary Clinics of North America: Small Animal Practice. 24 (1) 25-65
*Okerman, L. (1988) '''Diseases of Domestic Rabbits'''. Blackwell Scientific Publications ISBN 0-632-02254-X

{{Learning
|Vetstream = [https://staging.vetstream.com/lapis/Content/Freeform/fre00328 Oxyuriasis in rabbits] [https://staging.vetstream.com/lapis/Content/Freeform/fre00329 Trichostrongylosis in rabbits]
}}

[[Category:Endoparasitism_–_Rabbit]][[Category:To Do - Exotics]][[Category:To Do - Medium]]

Nematode Infestation – Rabbit

2015-08-25T18:03:20Z

BaraStudent:

==Introduction==
Nematode infestations are extremely uncommon in pet rabbits.

The stomach worm, ''Graphidium strigosum'', may cause ulceration and gastric perforation in wild rabbits and in pets, but are extremely rare in my experience.

==Clinical signs==
They include loss of weight and even death (Okerman 1988). The worms are red and measure 1-2 cm and are found on the mucosa of the stomach (Okerman 1994).

The intestinal worm, ''Trichstrongylus retortaeformis'', which may cause irritation of the small intestine arises when greens or grass are fed. Okerman records this as occurring very rarely in animals kept on wire mesh (1988).

The caecal worm, ''Passalurus ambiguus'', is quite common and is apparently harmless, but can give rise to anal irritation (even to the extent of rectal prolapse) and lack of thrift. It is usually diagnosed coincidentally on examination of faeces for other purposes. However Gentz et al (1995) state that clinical signs of passaluriasis include decreased weight gain, diminished activity, constipation, impaction or intussusception. They also state that the use of a sellotape strip to attempt to harvest eggs from around the anus (as described in oder references) is counter-productive as the rabbit pinworm does not deposit eggs around the anus.

==Treatment==
Treatment for all nematodes in pet rabbits includes the oral use of piperazine adipate (daily for two days), fenbendazole (once only Panacur®; Intervet). Hillyer (1994) quotes Patton and states that ivermectin is ineffective against passaluriasis

==References==
*Gentz, E. J. et al. (1995) Dealing with gastrointestinal, genitourinary and musculoskeletal problems in rabbits: Veterinary Medicine 90 (4) 365-372
*Hillyer, E. V. (1994) '''Pet Rabbits'''. Veterinary Clinics of North America: Small Animal Practice. 24 (1) 25-65
*Okerman, L. (1988) '''Diseases of Domestic Rabbits'''. Blackwell Scientific Publications ISBN 0-632-02254-X

{{Learning
|Vetstream = [https://staging.vetstream.com/lapis/Content/Freeform/fre00328 Oxyurasis in rabbits]
}}

[[Category:Endoparasitism_–_Rabbit]][[Category:To Do - Exotics]][[Category:To Do - Medium]]

Giardiasis

2015-08-25T17:59:40Z

BaraStudent:

{{OpenPagesTop}}
Also known as: '''''Giardiosis — Giardosis — Giardia Infection — Lambliasis — Lambliosis

==Introduction==
[[Image:Giardia Cyst.jpg|thumb|right|200px| Giardia cyst from a dog. Source: Wikimedia Commons; Author: Joel Mills (2006)]]
''[[Giardia]]'' is a binucleate, flagellate protozoa that causes enteric infection giardiasis in dogs and occasionally cats and reptiles. ''[[Giardia]]'' species have been reported to be found in 1-39% of faecal samples from dogs and cats, with a higher rate of infection in younger animals. Transmission is via cysts that are shed in the faeces, and may be direct or indirect. Indirect water-borne transmission is the most common modality and is favoured by cool, moist conditions that prolong cyst survival. Once cysts are ingested, motile trophozoites are released and attach to the cells of the small intestinal mucosa via an adhesive disc. Predilection sites in the dog are the duodenum and jejunum, whereas only the duodenum is favoured in cats. Multiplication by binary fission can then occur, and trophozoites encyst to a stage adapted for survival in the external environment. Cysts are seen in the faeces from day 3 post-infection in dogs (5-16 in cats), and can survive in the environment for several months. Animals that mount an immune response to ''[[Giardia]]'' can eliminate infection; however, the immunity acquired does not necessarily prevent re-infection after a short period.

Giardiasis is a condition of significant zoonotic concern. Although the cat protozoa ''G. felis'' seems to be species-specific, dogs can host both the canine-specific ''G. canis'' and ''G. lamblia'' (characterised by twin eye-like anterior nuclei), which has zoonotic genotypes. It is not known how important dogs are as a reservoir for human ''[[Giardia]]'' infection, or how frequently zoonotic transmission occurs. ''G. lamblia'' is the protozoa most often involved in reptilian infections, so should be considered a zoonotic risk. In man, ''[[Giardia]]'' may cause acute diarrhoea, particularly in immunocompromised individuals. Subclinical infections also occur. Therefore strict hygiene should be employed to prevent faecal contamination.

==Signalment==
[[Image:Giardia lamblia.jpg|thumb|right|200px| ''Giardia lamblia''. Source: Wikimedia Commons; Author: Janice Carr (2006)]]
Dogs are more commonly affected than cats. There are no age, breed or sex predispositions for ''[[Giardia]]'' infection, but puppies and kittens are more likely to contract clinical disease than adult animals. Disease may also be seen in immunocompromised or stressed individuals.

Many other pets, including small mammals, reptiles, and livestock can be infected and a source of environmental contamination.

==Diagnosis==
===Clinical Signs===
Clinical signs are most likely to be seen in younger or immunocompromised animals, as healthy, older hosts are usually infected asymptomatically. Signs vary from acute, chronic or intermittent diarrhoea to chronic loose, fould-smelling faeces, and frequency of defaecation is usually increased. The stools are normally light coloured and mucoid and often contain fat. Blood is not normally present in the faeces. Vomiting, flatulence and weight loss/failure to gain weight may be seen in some cases, and the hair coat may be poor. Giardiasis may also cause malabsorption, and there are several proposed mechanisms for this. For example, the small intestinal villi may be grossly atrophied or damaged ultrastructurally, or giardiasis may lead to bacterial overgrowth. There is also evidence that ''[[Giardia]]'' consumes bile acids, preventing digestion of fats.

===Laboratory Tests===
[[Image:Giardiasis duodenum high power.jpg|thumb|right|200px|Giardia trophozoites in the duodenum. Source: Wikimedia Commons; Author: Nephron (2009)]]
Diagnosis is confirmed by demonstrating ''[[Giardia]]'' antigen, trophozoites or cysts in the faeces. The simplest method is to examine fresh faecal smears for cysts (and occasional trophozoites), but sensitivity is improved by using concentration techniques. Centrifugal flotation in zinc sulphate solution or sugar flotation solution are both appropriate, but zinc sulphate solution is preferred as it causes minimal distortion to cysts. In this technique, faecal material is centrifuged and saturated with zinc sulphate mixture before the fluid from the top of the tube is placed on a microscope slide. Diff-Quik or Lugol's iodine are used to stain cysts and trophozoites, a coverslip is applied, and the slide is examined under the microscope. Although infrequently detected, ''[[Giardia]]'' trophozoites are approximately 8 x 15 micron tear-drop shaped organisms which contain two nuclei. They can sometimes be seen to move in a "falling leaf" pattern. Cysts are around 12 microns long and, if not distorted, oval in shape. When looking for cysts, three samples collected at two to three day intervals should be examined as shedding is intermittent.

Commercial [[ELISA testing|ELISA tests]] are now available for the detection of ''[[Giardia]]'' antigen in faeces. These include the Snap ''[[Giardia]]'' test from IDEXX and the ProSpectT/Giardia ELISA from Alexon-Trend.

===Endoscopy===
The above tests may also be performed using duodenal aspirates obtained by endoscopy.

===Pathology===
Gross lesions are not normally found at post-mortem examination. Giardia trophozoites may be seen in the lumen following intestinal biopsy.

==Treatment==
It is particularly important to treat giardiasis in animals owing to its zoonotic potential. In the UK, '''fenbendazole''' is licensed for use against ''[[Giardia]]''. '''Metronidazole''' may also be used in dogs and cats but it is important to confirm the respective doses. However, metronidazole is only 67% effective in dogs and has a bitter taste. A combination of febantel, praziquantel and febantel (Drontal Plus) can be used in dogs. Metronidazole is the recommended treatment for reptiles. Following treatment, it is advisable to repeat faecal examinations to confirm the efficacy of treatment and to detect re-infection. As well as drug therapy, thorough cleaning and disinfection of the environment and the animal's belongings is essential. Shedding of cysts can be difficult to detect and so in contact animals may be treated concurrently.

A vaccine comprising killed trophozoites has been developed and is available in the USA for use in dogs and cats. The vaccine decreases the excretion and viability of ''[[Giardia]]'' cysts, thus reducing the environmental burden.

==Prognosis==
Treatment is usually effective and the prognosis for treated giardiasis in dogs and cats is good. However, chronic infection may lead to debilitation.

{{Learning
|literature search = [http://www.cabdirect.org/search.html?q=%28%28title%3A%28Giardiasis%29+OR+title%3A%28Giardiosis+%29+OR+title%3A%28Giardosis+%29+OR+title%3A%28%22Giardia+Infection+%22%29%29%29+OR+%28%28title%3A%28%22Lambliasis+%22%29+OR+title%3A%28lambliosis%29%29%29 Giardiasis publications]
|full text = [http://www.cabi.org/cabdirect/FullTextPDF/2010/20103310400.pdf '''Giardia and giardiasis.''' Ivanov, A. I.; Faculty of Veterinary Medicine, Trakia University, Stara Zagora, Bulgaria, Bulgarian Journal of Veterinary Medicine, 2010, 13, 2, pp 65-80, many ref.]
|flashcards = [[Small Mammals Q&A 11]] [[Reptiles and Amphibians Q&A 23]]
|Vetstream = [https://staging.vetstream.com/lapis/Content/Freeform/Fre00402 Giardiasis in rabbits]
}}

==Links==
*[http://www.cfsph.iastate.edu/Factsheets/pdfs/giardiasis.pdf Giardiasis factsheet from The Center for Food Security and Public Health, Iowa State University]
*[http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/21300.htm The Merck Veterinary Manual - Giardiasis]
*[http://www.merck.com/mmhe/sec17/ch196/ch196h.html The Merck Online Medical Library - Giardiasis in humans]
*[http://www1.agric.gov.ab.ca/$department/deptdocs.nsf/all/agdex736 Government of Alberta, Agriculture and Rural Development - Giardia in Dogs]

==References==
*Fisher, M (2002) Endoparasites in the dog and cat: 2. Protozoa. ''In Practice'', '''24(3)''', 146-153.
*Frye, FL & Williams, DL (1995) '''Self-Assessment Colour Review - Reptiles & Amphibians''' ''Manson''
*Taylor, M A and Webster, K A (1998) Recent advances in the diagnosis of Cryptosporidium, Toxoplasma, Giardia and other protozoa of veterinary importance. ''Research in Veterinary Science'', '''65''', 183-193.
*Papasouliotis, K and Gruffydd-Jones, T (1996) Practical Approach to Diarrhoes in the Cat. ''In Practice'', '''18(5)''', 206-214.
*Tilley, L P and Smith, F W K (2007) '''The 5-minute Veterinary Consult (Fourth Edition)''' ''Blackwell Publishing''.
*Rutgers, H C (1989) Diarrhoea in the Cat. ''In Practice'', '''11(4)''', 139-148.
*Merck & Co (2008) '''The Merck Veterinary Manual (Eighth Edition)''' ''Merial''

{{review}}

{{OpenPages}}

[[Category:Expert_Review]]
[[Category:Intestinal Diseases - Dog]]
[[Category:Intestinal Diseases - Cat]]
[[Category:Zoonoses]]
[[Category:Snake Diseases]]
[[Category:Lizard Diseases]]
[[Category:Expert Review - Exotics]]
[[Category:Rabbit Digestion]]
[[Category:Rodent - Alimentary System]]

Gastric Stasis – Rabbit

2015-08-25T17:56:38Z

BaraStudent:

Gastric stasis is reasonably common in pet rabbits.

==Diagnosis of gastric impaction/stasis==
*Careful palpation of the anterior abdomen
*Radiography: Barium, in a healthy rabbit
**solid reaches caecum in up to 4 hours
**liquids may take more than 12 hours
*General clinical assessment, especially for any likelihood of skin disease

Radiography confirms the presence of impacted gastric contents surrounded by a halo of gas (Hillyer 1994). The presence of a small gas “cap” in the fundus is normal. In gastric stasis a “halo” encircles the contents (Girling 2006). The contents vary but are usually composed of fur, fibre (from food), and/or foreign material (usually unsuitable fibre substitute eg. wood-based litter; grass cuttings from a lawn mower, paper). The intake of fur may be inversely related to the fibre content of the diet and mild cases involving gastric trichobezoars may be successfully treated by correcting the fibre content of the diet, but the clinician should also check for pruritic skin conditions and treat as required.

==Clinical signs==
*Gradually progressive inappetance
*Decrease in output and size of faecal pellets to zero
*Compensatory polydypsia
*Bright for a few days after anorexia
*Pica – the rabbit eats paper, cardboard, wood
*Not painful
*Depression, lethargy, dehydration and death

It is possible to palpate the "doughy" mass in the epigastric area – take care. Gastric rupture is easy to produce! As the condition progresses to non-obstructive ileus see [[Non-Obstructive Ileus – Rabbit|here]].

==Treatment==
Except on the extremely rare occasions when large trichobezoars can be confirmed possibly by endoscopy it is usually sufficient just to flush the offending material from the stomach. The use of a naso-oesophageal tube and administration of isotonic probiotic/electrolyte and monosaccharide solution is recommended. (Note: A small, flexible, atraumatic endoscope is required in this species but endoscopy of the rabbit stomach is difficult, due to the well-developed cardic sphincter and the fact that the stomach is nearly always full and contains material which is difficult to control so it gets in the way!)

The use of mild laxatives (Liquid Paraffin BPC, or preferably, MilPar; Sterling Health: given twice or three times a day, by stomach tube or by naso-oesophageal tube), may be considered.

Oral doses of metoclopramide and cisapride seem to work synergistically in assisting gastric emptying. Cisapride is now extremely difficult to obtain and some clinicians are using ranitidine.

Analgesia:
*Buprenorphine
*Butorphanol
*Carprofen

Assisted feeding:
*Oxbow Critical Care (PetLife email petlife@vetbed.co.uk)
*Hay, grass, high fibre foods – we find that nearly all rabbits will take Timothy hay in our hospital.

Simethicone if large amounts of gas are present.

Avoid antibiotics?

Exercise is important to promote gastrointestinal motility.

The administration of bromelain (10 ml of raw fresh pineap¬ple juice two or three times a day (Okerman 1988 for four to five days) – this is supposed to “tenderise” the keratin in fur-balls – it certainly doesn’t seem to do any harm and may even break down the protein matrix in small clumps of fur. Its main benefit is probably as a source of fluids.

Gastrotomy (recommended by Gentz et al 1995 if the signs are not resolved more than 2 weeks after the start of oral fluids) must be followed by all the medical treatments listed above and given 48 hours after surgery and immediate forced exercise (the rabbit is placed in a box with a fitted carpet on the floor and the box is tilted to make it walk to the opposite end and back again for several minutes several times a day) - Burke 1992

To apply a naso-oesophageal feeding tube, proceed as follows:
#Take a FG 5 - 8 feeding tube. Make additional holes in the caudal aspect of the tube.
#Apply local anaesthetic (Minims® Ophthalmic Amethocaine or Proxymetacaine; Bausch and Lomb Pharmaceuticals) drops to the nostrils and wait for 3 - 5 minutes for it to take effect.
#Measure the tube length from external nares to the caudal end of the sternum and mark the position of the nostril with tape or pen.
#Lubricate the tube with KY Jelly® (Johnson and Johnson). (If local anaesthesia is adequate the tube should move without resistance or discomfort).
#Restrain the rabbit with or without a towel in sternal recumbency on the non-slip table-top.
#Elevate the head. Place the lubricated tube in the ventral nasal meatus directing it medially and ventrally
#Return the rabbit's head to the normal flexed position as the tip of the tube approaches the pharynx so that it passes down the oesophagus and avoids the larynx and trachea – the rabbit does not cough sufficiently obviously to give you warning that the tube may be misdirected. See step 9.
#If there is resistance, remove the tube and use the other nostril (ie repeat steps 2, 5, 6 and 7).
#If the tube is placed endotracheally, there may be a change in the breathing pattern, presence of breath sounds and intraluminal condensation. As this is not reliable, you should assess proper placement by radiography. Assessing the site of the caudal end of the tube by injection of saline is not appropriate as, in my experience, the rabbit does not always cough when the saline (or tube) is placed in the trachea. The distal end of the tube may be found in the stomach or distal oesophagus. If necessary, the tube should be withdrawn until it lies in and the end of the caudal oesophagus - not in the lumen of the stomach where it can be adversely affected by gastric acid. Suture or superglue the tube to the head of the rabbit (over the bridge of the nose and at the base of the ears). I use an Elizabethan Collar only if the animal shows signs of disturbing the tube. Natural caecotrophy is obviously not possible when the animal is wearing an Elizabethan Collar so caecotrophs have to be harvested and fed to the animal.
#The tube may now be used for the administration of fluids or blended foods. To avoid blockage of the tube strain the dry blended food (shake it through a coffee strainer or flour sieve) prior to suspending it in fluid and flush the tube with water after administration. Administering blended caecotrophs may be attempted but should not be necessary as the rabbit should be able for caeotrophy (and feeding) with the tube in place, unless an Elizabethan collar has been fitted.
#If the tube becomes blocked, it usually has to be replaced, but sometimes it can be flushed with warm water or even Coca-Cola® - the effervescence is supposed to relieve the blockages but I’ve never had to resort to it.

Offer Timothy hay and spring greens as if the tube was not fitted in the first place. The animal should be able to feed normally and it is imperative that it should be allowed to do so as the teeth continue to grow normally.

{{Learning
|Vetstream = [https://staging.vetstream.com/lapis/Content/Technique/teq00549 Nasogastric intubation of rabbits] [https://staging.vetstream.com/lapis/Content/Freeform/fre00011#section2 Gastric dilation and stasis]
}}

==References==
*Gentz, E. J. et al (1995) Dealing with gastrointestinal, genitourinary and musculoskeletal problems in rabbits. Veterinary Medicine, 90 (4), 365-372
*Girling, S. J. (2006) Diagnostic Imaging in '''BSAVA Manual of Rabbit Medicine and Surgery''', eds Meredith A and Flecknell P, 2nd Edition 2006, published by BSAVA Quedgley Glocs

[[Category:Rabbit Digestion]]

Gastric Dilation and Intestinal Obstruction – Rabbit

2015-08-25T17:55:24Z

BaraStudent: /* References */

===Introduction: gastric dilation and gut stasis===
Gastric stasis must be differentiated from gastric dilation which is usually associated with intestinal obstruction. Gastric dilation develops rapidly, suddenly and unexpectedly, whereas gut stasis develops slowly and insidiously, usually followed by a painful or stressful episode. Note that a moving foreign body could mimic gut stasis except that the stomach is not impacted (stomach may or may not be impacted).

For more information, see:
*Harcourt Brown F M (2007), Gastric dilation and intestinal obstruction in 76 rabbits. Veterinary Record, 161, 409 – 414, and
*Harcourt Brown T R (2007) Management of Acute Gastric Dilation in Rabbits. Journal of Exotic Pet Medicine, 16, (3) 168 – 174

===Pathophysiology===
(Pathological) obstruction of small intestine accompanied by (physiological) continuous production of saliva which leads to:
*Accumulation of fluid in stomach and small intestine cranial to obstruction
*Fermentation => gas production
*Painful gastrointestinal dilation
*Reduced gut motility
*Secondary ileus.
*Sequestration of fluid => electrolyte and acid-base imbalances and hypovolaemia (and the necessity of fluid therapy.
*Passage of blockage to hind gut
**note dilation of gut proximal to obstruction
*Non-passage of the blockage leads to devitalisation and necrosis of intestine

===Clinical Signs of Gastric Dilation===
*Anorexia
*Depression
*Moribund/unresponsive
*Death (due to peritonitis or shock)
*Distended stomach palpable in left epigastric area caudomedial to left last rib and confirmed radiographically
*Abdominal pain or flaccidity

===Causes of intestinal obstruction===
*Compressed hair
*Intestinal neoplasia
**Lymphoma
*Foodstuff
*Post-spay adhesions
*Post-castration strangulated hernia
*Foreign fibre
*Tapeworm cysts
*Diverticulosis

===Pellets of compressed hair===
They are acquired by:
*grooming/moulting
*Ingestion of matted hair
*Ingestion of hair in caecotrophs
*Predisposed by low-fibre diets

===Sites and causes of obstruction===
*Pylorus (Deeb 2000; Jenkins 2003)
*Proximal duodenum
**foreign bodies
**mid-small intestine
**foreign bodies
**neoplasia
**strangulated hernia
**diverticulosis
*Ileocaecocolic junction
**foreign bodies
**neoplasia
*Large intestine
**neoplasia
**carpet fibre at fusus coli
**postspay adhesions
**tapeworm cysts along attachment with small intestine

'''NB: Severity of prognosis is directly proportional to closeness of site of obstruction to pylorus.'''

===Case assessment===

{| border="2" align="center" cellspacing="0" cellpadding="4" rules="all"; border-collapse:collapse;empty-cells:show"
|+
!bgcolor="#FFCC99"| Clinical signs
!bgcolor="#FFCC99"| Radiographic signs
!bgcolor="#FFCC99"| Conclusion
|-
|bgcolor="#FFFFCC"| Unresponsive; collapsed; hypothermic; abdominal pain; +/- gastric dilation
|bgcolor="#FFFFCC"| Gas in stomach and intestine; free gas in peritoneal cavity
|bgcolor="#FFFFCC"| Ruptured gut; explorotomy; euthanasia
|-
|bgcolor="#FFFFCC"| Unresponsive; abdominal pain; gastric dilation palpable
|bgcolor="#FFFFCC"| Gas/fluid in stomach; minimal gas in intestine
|bgcolor="#FFFFCC"| Cranial sm int obstruction; gastric decompression and surgery; euthanasia
|-
|bgcolor="#FFFFCC"| Unresponsive; abdominal pain; gastric dilation palpable
|bgcolor="#FFFFCC"| Gas/fluid in stomach; much gas in small intestine
|bgcolor="#FFFFCC"| Caudal sm int obstruction; repeat rads (30-60 mins) or perform gastric decompression
|-
|bgcolor="#FFFFCC"| Depressed; not collapsed; palpably enlarged stomach
|bgcolor="#FFFFCC"| Gas in caecum
|bgcolor="#FFFFCC"| Foreign body has passed through; medical treatment
|-
|}

''Performing surgery only to find that the obstruction has moved is preferable to performing a post-mortem examination on a rabbit that required surgical intervention.'' (Harcourt Brown T R (2007), Journal of Exotic Pet Medicine. 16, (3) 168-174)

===Procedure with a case of gastric dilation===

Radiograph under opiate analgesia - fentanyl/fluanisone ((Hypnorm; Janssen-Cilag) SC once only or buprenorphine (Vetergesic; Alstoe) plus meloxicam (Metacam; Boehringer Ingelheim) or carprofen (Rimadyl; Pfizer).
Prepare orthogonal radiographs - lateral and dorso-ventral with legs extended or ventro-dorsal views. Observe the dilation of the stomach and the presence and distribution of fluid (liquid and gas) in the gastrointestinal tract to identify location of obstruction. Note the degree of contact of the dilated stomach with the ventral abdominal wall. Assess the amount of gas in the small intestine and look for gas in the large intestine. If no gas in hindgut and stomach severely dilated it may be best to go for euthanasia. Free gas in peritoneum indicates rupture of the gastrointestinal tract and justifies euthanasia. A search for other pathology may indicate other problems like bladder stones, spinal arthritis etc and may also indicate euthanasia.

Pit-falls of radiography: Caecum and large intestine generally do not have large amounts of gas in normal rabbits BUT caecum and large intestine generally do not have no gas in obstructed rabbits Caecum and large intestine with gas and dilated stomach seen in cases carrying a better prognosis.

Search for peritoneal gas in rabbits with severe depression If found, this is an indication of rupture of the intestine and indicates euthanasia. Remember euthanasia always an option

Serial radiographs (every 30 – 90 minutes) looking for gas in hindgut. If gas in hind gut this indicates that the obstruction is moving - administer NSAIDs (carprofen or meloxicam) if not already administered (see above) - followed by prokinetics if still anorectic after 2-3 hours.

Fluid accumulation in stomach leads to deficit in intra- and extra-cellular compartments. Parenteral fluids required. Give Hartmann’s/kg /hr IV.

Exploratory surgery may be attempted. Decision of whether to embark on surgery or conservative treatment depends on the time of presentation and on financial considerations:
*Day => conservative treatment
*Night => surgery more likely

===Surgical Procedure===
*Insert stomach tube to decompress: if it blocks, remove, flush and replace
**Procedure of gastric decompression
***+/- sedation
***mouth to last rib
***gentle gastric massage
***patience
***minimal suction
***intermittent retropulsion
***if tube is placed inadvertently endotracheally there will be
*a change in breathing pattern
*the presence of breath sounds at the free end of the tube
*intraluminal condensation
*Gastric rupture => euthanasia
*Intestinal rupture => euthanasia
*Intestinal neoplasm => euthanasia
*Intestinal FB milked through ileocaecocolic junction into the hind gut or perform an enterotomy.
*Note small omentum so omentalisation may not be possible
*Postoperatively give antibiotics, prokinetics, food (force fed with Oxbow Critical Care Formula and baby cereal)

===Practical approach to exploratory laparotomy in rabbits with intestinal obstruction===
#Opiate premedication, oxygenation, gastric and tracheal intubation and isoflurane maintenance.
#Incision midline, sternum to umbilicus
#Inspect retroperitoneum for fluid/ingesta
#Palpate stomach and descending duodenum
#Palpate ascending duodenum (under caecum)
#Palpate jejunum cranially and caudally
#Look for flattened intestine caudal to obstruction
#Examine site of obstruction for contributive or subsequent pathology: cytology/biopsy?
#Milk obstruction to hindgut or stomach
#Gastrotomy/enterotomy/ectomy???
#Closure with Vicryl (not catgut)

===Complications of rabbit intestinal surgery===
*Insufficient omentum for omentalisation
*Intestine small and thin-walled
*Food cannot be withheld during post-operative period
**danger of hepatic lipidosis

===Postoperative care===
*Warmth, quiet
*Fluid therapy
*Analgesia
*Antibiotics
*Prokinetics
*Food (grass, dandelions)
*Gavage with Oxbow CCF and Baby cereal

{{Learning
|Vetstream = [https://staging.vetstream.com/lapis/Content/Freeform/fre00011#section2 Gastric dilation and stasis]
}}

==References==
*Deeb, B. (2000) Digestive System and Disorders in '''Manual of Rabbit Medicine and Surgery''', ed. Paul Flecknell pub BSAVA Cheltenham Glos Pages 39 - 46
*Harcourt Brown, F. M. (2007) '''Gastric dilation and intestinal obstruction in 76 rabbits'''. Veterinary Record, 161, 409 – 414
*Harcourt Brown, T. R. (2007) '''Management of Acute Gastric Dilation in Rabbits'''. Journal of Exotic Pet Medicine, 16, (3) 168 – 174

[[Category:Rabbit Digestion]]

Non-Obstructive Ileus – Rabbit

2015-08-25T17:53:24Z

BaraStudent: /* Prognosis */

{{OpenPagesTop}}
Also known as: '''''Gastrointestinal Hypomotility'''''

==Introduction==
This describes '''increased intestinal transit time''' and decreased frequency of caecocolonic segmental contractions.

Proper hindgut fermentation and gastrointestinal tract motility are dependent on the ingestion of large amounts of roughage and long-stemmed hay. Ileus can be caused by diets that contain '''inadequate amount of fibre''', such as muesli-type diets.

When gastrointestinal motility slows down, '''ingesta accumulates in the stomach'''. Dehydration of stomach contents often occurs, which makes passing the contents even more difficult. If the hypomotility is not treated, electrolyte imbalances and shifts in the intestinal microbial flora can occur and can be fatal.

The rabbit '''stops eating''', '''faecal pellet production slows''' and stops and there are alterations in the enteric microflora population. This can lead to overgrowth of ''E. coli'' and ''Clostridia'' spp which exacerbate the ileus.

Surgery, stress, changes in environment and anorexia due to other diseases can all precipitate ileus.

If a rabbit presents with ileus, '''the priority is to treat the condition''', aggressively if necessary. Further investigations into the cause of the ileus can be performed once the rabbit is stable.

==Clinical Signs==
The rabbit may present due to '''decreased appetite or anorexia'''.

The owner may report: '''abnormal faecal production''', with either no or a reduced amount of pellets, liquid faeces or mucoid pellets

'''Pain''' may be manifest as: hunched posture, tooth grinding, shallow rapid respirations, tender abdomen on palpation.

'''Intestinal sounds''' may be abnormal: negative or increased borborygmi, increased caecal resonance.

The rabbit may be '''hypothermic'''.

On '''abdominal palpation''', the stomach may be hard, distended and remains pitted on compression.

==Diagnosis==
History and clinical signs are highly usually suggestive of the condition.

On '''radiographs''' there will be moderate to severe distention of the stomach with ingesta. A halo of gas may be present around the stomach contents. '''Gas distention''' is also common throughout the gastrointestinal tract, including the caecum.

Absence of faecal balls in the colon is also highly suggestive.

==Investigation of Ileus==
Investigation of the cause of ileus should include:

Full history: details of the diet fed, previous surgeries, any stressful situations

Clinical examination: dental examination, signs of musculoskeletal disease, neurological problems

Biochemistry: raised liver enzymes may indicate pathology causing pain

Haematology: may indicate chronic disease or infection

''E. cuniculi'' serology: infection may be involved in neurological problems affecting food prehension or ingestion

Radiography: looking for signs of dental disease, osteoarthritis, neoplasia, foreign bodies

Ultrasound: allows more complete assessment of the liver, kidneys and bladder

Faecal analysis: may be difficult if there is a lack of faecal output, but once it returns may provide information on parasites, digestion etc..

==Treatment==
Aggressiveness of therapy depends on the severity of the presenting signs.

Aims should include:

Analgesia: NSAIDs like meloxicam or opioids like buprenorphine depending on the signs

[[:Category:Fluid Therapy|Fluid therapy]]: the aim is to '''rehydrate the gut contents and/or to rehydrate the rabbit'''. Oral fluids can be given along with intra-venous fluid therapy. Intra-peritoneal and intra-osseous routes can also be used if venous access is impossible. Sub-cutaneous fluids are not particularly helpful.

Supportive nutrition: the aim is to provide '''long indigestible fibre''' to stimulate the fusus coli, however in the first instance, any food is better than none and the rabbit can be tempted with its favourites. It can be '''syringe-fed''' products made for critical care feeding of rabbirs.

Pro-kinetics: '''Ranitidine''' is the most useful, but metoclopramine and cisapride have also been used.

Exercise: this helps to stimulate gut motility and good hospitalisation away from predators, good analgesia and good nursing will all encourage the rabbit to exercise.

'''In the long term''', the rabbit should be fed a diet high in fibre and low in carbohydrates to avoid the condition occurring again.

Owners should be taught to monitor faecal output so that small changes and early disease will be dealt with promptly.

==Prognosis==
Depends on the underlying cause.

Early medical management of animals with ileus carries an '''excellent prognosis'''.

{{Learning
|flashcards = [[Rabbit Medicine and Surgery Q&A 08]]
|Vetstream = [https://staging.vetstream.com/lapis/Content/Illustration/ill00120 Radiograph of a rabbit with ileus]
}}

==References==
Girling, S. J. (2006) Diagnostic Imaging in '''BSAVA Manual of Rabbit Medicine and Surgery''', eds Meredith A and Flecknell P, 2nd Edition 2006, published by ''BSAVA Quedgley Glocs''

Oglesbee, B. (2006) '''The 5-minute veterinary consult: ferret and rabbit''' ''Wiley-Blackwell''

Sayers, I. (2011) '''Ileus in Rabbits''' ''RVC Small Mammal elective student notes''

{{review}}

{{OpenPages}}

[[Category:Expert Review - Exotics]]

[[Category:Rabbit Digestion]]

Enterotoxaemia Treatment - Rabbit

2015-08-25T17:51:15Z

BaraStudent:

==Synopsis of treatment for enterotoxaemia and bacterial enteritis==
*Warmth up to 27°C
*Fluid therapy
**Hartmann’s is probably better than dextrose-containing fluids (Clostridial toxins “feed” on monosaccharides)
**intravenous or intraosseous.
**maintenance = 100ml/kg/day
*Analgesia
**buprenorphine
**butorphanol
**carprofen
*Cholestyramine resin (Questran, Bristol-Myers Pharmaceuticals) - rabbit must be well-hydrated because the same chain of events occur when ispaghula husk (psyllium) is given to rabbits (see anatomy and physiology of the digestive tract).
*Antibiotics are indicated if it is a true bacterial enteritis but should be avoided if ''Salmonbella'' sp. is isolated.
*Probiotics. ''Lactobacillus'' spp are claimed to attach to mucosa and compete with pathogenic bacteria.
*Transfaunation
**Caecotrophs collected from a healthy rabbit
**Elizabethan collars
**Fed whole to maintain the protective mucus coating
*Rabbits with diarrhoea should never be starved
**Ad lib hay and leafy greens. Dandelions, parsley, freshly pulled (not cut) grass and groundsel
**Assisted feeding – commercial high fibre products for herbivores are available (eg). Most rabbits will accept food orally may be necessary.
**Vitamin C may be of use in limiting the absorption of iota toxins and improving mucosal integrity
**Oxbow Critical care for herbivores,
**Supreme Recovery Diet via a syringe or nasogastric intubation

==References==
*Bell, J. C., Palmer, S. R. and Payne, J. M. (1988). '''The Zoonoses'''. Edward Arnold, London. ISBN 0-7131-4561-7
*Carman, R. J. (1994) Clostridial enteropathies of rabbits. Journal of Small Exotic Animal Medicine. 2 (4), 179-181
*Okerman, L. (1994) '''Diseases of Domestic Rabbits'''. Blackwell Scientific Publications ISBN 0-632-03804 -7. 2nd Edition
*Walden, N. B. (1990) '''Rabbits - A Compendium'''. The T.G. Hungerford Vade Mecum Series for Domestic Animals. Series C Number 13 Published by the University of Sydney Post Graduate Foundation In Veterinary Science March 1990 ISBN 0909973 80 6 ISN 0812 0048

{{Learning
|Vetstream = [https://staging.vetstream.com/lapis/Content/Freeform/fre00012 Enterotoxemia (Clostridiosis)]
}}

{{unfinished}}
[[Category:To Do - Exotics]][[Category:To Do - Medium]]
[[Category:Enteropathies_-_Rabbit]]

Category:Enteropathies - Rabbit

2015-08-25T17:49:02Z

BaraStudent:

{{frontpage
|pagetitle =Enteropathies - Rabbit
|pagebody = Bacterial enteropathies should really be regarded as "overgrowths".
|contenttitle =Content
|contentbody =<big>
<categorytree mode=pages>Enteropathies - Rabbit</categorytree>

</big>
|logo =800px-Coello GDFL000.jpg
}}

{{Learning
|Vetstream = [https://staging.vetstream.com/lapis/Content/Freeform/fre00015 Enteritis enteropathy in rabbits]
}}

[[Category:Rabbit Digestion]]

Colibacillosis - Rabbit

2015-08-25T17:46:34Z

BaraStudent:

==Introduction==
It can be encountered in pet rabbits of all ages, especially if they have been receiving doses of antibiotics that include gram-positive organisms in their spectrum of activity (Morisse 1978). This can be a particular problem if animals from different sources are mixed together on acquisition, especially in conditions of indifferent hygiene. The quality of the diet (especially the protein/cellulose ratio) and of the drinking water is also of aetiological importance. The levels of ''E. coli'' in the intestinal lumen of a rabbit rises directly in proportion to infestation with ''Eimeria'' species (coccidians).

==Clinical Signs==
*profuse diarrhoea
*fur-chewing
*anorexia

==Treatment==
Treatment is usually unrewarding.
*Oral administration of broad-spectrum antibiotics with known activity against gram-negative organisms, including ''E. coli''.
*Antispasmolytic agents such as hysocine (Buscopan Compositum; Boehringer Ingelheim 1 mg per kilogram I/M or S/C once only or daily until the desired results are obtained)
*Fluids. Okerman (1994 p 37) warns that finding ''E. coli'' in large numbers merely reflects the ability of the organism to reproduce post-mortem and does not necessarily prove the diagnosis.

==References==

*Okerman, L. (1994) '''Diseases of Domestic Rabbits'''. Blackwell Scientific Publications ISBN 0-632-03804 -7. 2nd Edition

{{Learning
|Vetstream = [https://staging.vetstream.com/lapis/Content/Freeform/fre00014 Colibacillosis in rabbits]
}}

[[Category:Enteropathies_-_Rabbit]][[Category:To Do - Medium]][[Category:To Do - Exotics]]

Gastric Stasis – Rabbit

2015-08-25T14:19:09Z

BaraStudent:

Gastric stasis is reasonably common in pet rabbits.

==Diagnosis of gastric impaction/stasis==
*Careful palpation of the anterior abdomen
*Radiography: Barium, in a healthy rabbit
**solid reaches caecum in up to 4 hours
**liquids may take more than 12 hours
*General clinical assessment, especially for any likelihood of skin disease

Radiography confirms the presence of impacted gastric contents surrounded by a halo of gas (Hillyer 1994). The presence of a small gas “cap” in the fundus is normal. In gastric stasis a “halo” encircles the contents (Girling 2006). The contents vary but are usually composed of fur, fibre (from food), and/or foreign material (usually unsuitable fibre substitute eg. wood-based litter; grass cuttings from a lawn mower, paper). The intake of fur may be inversely related to the fibre content of the diet and mild cases involving gastric trichobezoars may be successfully treated by correcting the fibre content of the diet, but the clinician should also check for pruritic skin conditions and treat as required.

==Clinical signs==
*Gradually progressive inappetance
*Decrease in output and size of faecal pellets to zero
*Compensatory polydypsia
*Bright for a few days after anorexia
*Pica – the rabbit eats paper, cardboard, wood
*Not painful
*Depression, lethargy, dehydration and death

It is possible to palpate the "doughy" mass in the epigastric area – take care. Gastric rupture is easy to produce! As the condition progresses to non-obstructive ileus see [[Non-Obstructive Ileus – Rabbit|here]].

==Treatment==
Except on the extremely rare occasions when large trichobezoars can be confirmed possibly by endoscopy it is usually sufficient just to flush the offending material from the stomach. The use of a naso-oesophageal tube and administration of isotonic probiotic/electrolyte and monosaccharide solution is recommended. (Note: A small, flexible, atraumatic endoscope is required in this species but endoscopy of the rabbit stomach is difficult, due to the well-developed cardic sphincter and the fact that the stomach is nearly always full and contains material which is difficult to control so it gets in the way!)

The use of mild laxatives (Liquid Paraffin BPC, or preferably, MilPar; Sterling Health: given twice or three times a day, by stomach tube or by naso-oesophageal tube), may be considered.

Oral doses of metoclopramide and cisapride seem to work synergistically in assisting gastric emptying. Cisapride is now extremely difficult to obtain and some clinicians are using ranitidine.

Analgesia:
*Buprenorphine
*Butorphanol
*Carprofen

Assisted feeding:
*Oxbow Critical Care (PetLife email petlife@vetbed.co.uk)
*Hay, grass, high fibre foods – we find that nearly all rabbits will take Timothy hay in our hospital.

Simethicone if large amounts of gas are present.

Avoid antibiotics?

Exercise is important to promote gastrointestinal motility.

The administration of bromelain (10 ml of raw fresh pineap¬ple juice two or three times a day (Okerman 1988 for four to five days) – this is supposed to “tenderise” the keratin in fur-balls – it certainly doesn’t seem to do any harm and may even break down the protein matrix in small clumps of fur. Its main benefit is probably as a source of fluids.

Gastrotomy (recommended by Gentz et al 1995 if the signs are not resolved more than 2 weeks after the start of oral fluids) must be followed by all the medical treatments listed above and given 48 hours after surgery and immediate forced exercise (the rabbit is placed in a box with a fitted carpet on the floor and the box is tilted to make it walk to the opposite end and back again for several minutes several times a day) - Burke 1992

To apply a naso-oesophageal feeding tube, proceed as follows:
#Take a FG 5 - 8 feeding tube. Make additional holes in the caudal aspect of the tube.
#Apply local anaesthetic (Minims® Ophthalmic Amethocaine or Proxymetacaine; Bausch and Lomb Pharmaceuticals) drops to the nostrils and wait for 3 - 5 minutes for it to take effect.
#Measure the tube length from external nares to the caudal end of the sternum and mark the position of the nostril with tape or pen.
#Lubricate the tube with KY Jelly® (Johnson and Johnson). (If local anaesthesia is adequate the tube should move without resistance or discomfort).
#Restrain the rabbit with or without a towel in sternal recumbency on the non-slip table-top.
#Elevate the head. Place the lubricated tube in the ventral nasal meatus directing it medially and ventrally
#Return the rabbit's head to the normal flexed position as the tip of the tube approaches the pharynx so that it passes down the oesophagus and avoids the larynx and trachea – the rabbit does not cough sufficiently obviously to give you warning that the tube may be misdirected. See step 9.
#If there is resistance, remove the tube and use the other nostril (ie repeat steps 2, 5, 6 and 7).
#If the tube is placed endotracheally, there may be a change in the breathing pattern, presence of breath sounds and intraluminal condensation. As this is not reliable, you should assess proper placement by radiography. Assessing the site of the caudal end of the tube by injection of saline is not appropriate as, in my experience, the rabbit does not always cough when the saline (or tube) is placed in the trachea. The distal end of the tube may be found in the stomach or distal oesophagus. If necessary, the tube should be withdrawn until it lies in and the end of the caudal oesophagus - not in the lumen of the stomach where it can be adversely affected by gastric acid. Suture or superglue the tube to the head of the rabbit (over the bridge of the nose and at the base of the ears). I use an Elizabethan Collar only if the animal shows signs of disturbing the tube. Natural caecotrophy is obviously not possible when the animal is wearing an Elizabethan Collar so caecotrophs have to be harvested and fed to the animal.
#The tube may now be used for the administration of fluids or blended foods. To avoid blockage of the tube strain the dry blended food (shake it through a coffee strainer or flour sieve) prior to suspending it in fluid and flush the tube with water after administration. Administering blended caecotrophs may be attempted but should not be necessary as the rabbit should be able for caeotrophy (and feeding) with the tube in place, unless an Elizabethan collar has been fitted.
#If the tube becomes blocked, it usually has to be replaced, but sometimes it can be flushed with warm water or even Coca-Cola® - the effervescence is supposed to relieve the blockages but I’ve never had to resort to it.

Offer Timothy hay and spring greens as if the tube was not fitted in the first place. The animal should be able to feed normally and it is imperative that it should be allowed to do so as the teeth continue to grow normally.

{{Learning
|Vetstream = [https://staging.vetstream.com/lapis/Content/Technique/teq00549 Nasogastric intubation of rabbits]
}}

==References==
*Gentz, E. J. et al (1995) Dealing with gastrointestinal, genitourinary and musculoskeletal problems in rabbits. Veterinary Medicine, 90 (4), 365-372
*Girling, S. J. (2006) Diagnostic Imaging in '''BSAVA Manual of Rabbit Medicine and Surgery''', eds Meredith A and Flecknell P, 2nd Edition 2006, published by BSAVA Quedgley Glocs

[[Category:Rabbit Digestion]]