Gut Stasis AND Kidney Infection

oscarMeet Oscar
Oscar was a patient of mine who came in because he had some mild abnormalities – soft droppings, decreased interest in hay and some possible weight loss.  His owner had started Critical Care before bringing him in.  On exam he was definitely thin and his abdomen felt soft and doughy.

Diagnostics/Treatment
We took an xray of Oscar and found a ton of gas in the intestines!  Definitely gut stasis.  His blood work was normal and we started Oscar on various medications.  When he returned for his followup appointment, he wasn’t back to normal – more weight loss, still not eating well…Xrays showed improvements but not what we wanted to see so back onto treatments he went.

But Wait, There’s More
We saw Oscar for other issues 2 months later – but the xray still showed gas!  Since Oscar’s blood work was even better than previously we moved on to the next step.

PyelonephritisUltrasound
We found Oscar’s problem – both kidneys showed changes consistent with pyelonephritis (kidney infection).  We put Oscar on 6 weeks of heavy duty antibiotics and his kidneys improved.  There were no further episodes of weight loss or appetite changes.

How Can That Be?
Most of the time we aren’t able to identify the cause of gut stasis in rabbits and rodents like Oscar.  Pain, fear and stress are common causes that may be already gone by the time we see our patients.  Trying to figure out why the gut is slowing down is why we want to run tests like xrays and blood work.  Basically – what is going on inside and is there anything else we need to worry about…

Some diseases, like pyelonephritis, are hidden.  They don’t show up on xrays and they don’t make changes in the blood work until they’ve caused serious damage to organs.  That’s where advanced imaging such as ultrasounds, CT scans and even MRIs can make all the difference.

But, just like with Oscar, we don’t start there!  Oscar didn’t get better as fast as he should have and he had the gut stasis return.  At that point we could tell something wasn’t right – we were able to investigate further and find his hidden problem.

Boiling Water and Birds

Jasper and the Pot of Water

pot-883036_640We all fear accidents – all we can’t do is take reasonable precations.  But our pets sometimes outwit us and late last night Jasper flew into a pot of boiling water.  When I saw him the next day I explained to the owner that even though the legs looked pretty good, the true extent of the damage might not show up for several days.

The owner was not surprised since, as a cook, he was familiar with burn first aid care.  Jasper was bathed in warm (not cold) water initially and repeatedly.  Warm water helps stimulate blood flow which leads to long term improvements in healing.

Within 24 hours you can see the swelling starting already:

Initial swelling on the left leg

Initial swelling on the left leg

 

Irritation and swelling

Irritation and swelling

Regardless of the presentation, we treated for the possibility of very bad burns by starting Jasper on pain medication, antibiotics and topical treatments.  Sometimes wrapping a burn can be helpful but it depends on the location and the patient.  Jasper did well on his treatments and recovered fully.  He was lucky – many of our patients lose toes or worse.  It can be very hard to keep their pain under control and to medicate them frequently until the burns are healed.

Take a look at some of the changes to Jasper’s legs over the following weeks:

3 days later the skin is sloughing.

3 days later the skin is sloughing.

Improvements 11 days after the burn

Improvements 11 days after the burn

But now a thick scab is present

But now a thick scab is present

The scab is trimmed to prevent a constriction

The scab is trimmed to prevent a constriction

All healed after 1 full month of care

All healed after 1 full month of care

Rabbit and Rodent – Gut Stasis

Huh?  Gut Stasis?Guinea Pig
If you’re new to rabbits, guinea pigs and chinchillas you may not be familiar with a common problem – gut stasis.  This is a condition, from mild to severe, where normal gut movements start to slow down or stop entirely.  Without intervention your pet can die from this problem.

Let’s Back Up to Some Anatomy
rabbit giRabbits and some rodents (like guinea pigs and chinchillas) are hind gut fermenters.  Anyone familiar with horses knows what this means – they have a ton of large intestines and do most of their food processing there.  They do this through a large number of bacteria, hence fermentation.

Since it’s really difficult to digest grass or hay, these guys have a cecum and colon that actually separates large indigestible fibers from small fermentable particles and fluids.  The gut actually has two phases and switches from production of normal “hard feces” to cecotrophs of “soft feces” periodically throughout the day.  The cecotrophs are small, dark, soft feces that are packaged in a protective mucus coating.  You shouldn’t really see these as they get eaten as they are produced.  The mucus helps protect the cecotroph as it passes through the stomach in order to be re-digested.

What Causes the Gut to Slow Down?
Oh boy…here you go:

  • Pain
  • Diet (changes, not enough fiber, too many carbohydrates or proteins)
  • Stress (fright, fear, pain, poor home care, thunderstorms, the construction down the street…)
  • Husbandry Errors (overcrowding, lack of cleanliness…)
  • Other Illness (causing pain or stress)
  • Dental Disease
  • Diseases that Interfere with Eating
  • Medications that Disrupt the Gut
  • Certain Antibiotics (that disrupt the normal gut bacteria)

The Downward Spiral
So, once it starts it gets worse.  Slowed gut motility can lead to the build up of material in the stomach (trichobeozars), gas build up in the GI tract (resulting in pain), stomach ulcers, disruption of normal gut bacteria resulting in overgrowth, fatty liver disease … all things that contribute to making the problem worse.  As the food stays within the intestines, the body continues to remove fluids from the digesta.  Sometimes this can create a wad that is hard to get moving again or actually results in a fecal impaction.

What About Obstructions?
We used to think the trichobeozar in the stomach was the cause of their problems and needed to be removed – not anymore!  Experiments in the early ’80s proved the trichobeozar was the result of gut stasis and not the cause.  We don’t need to remove it unless there is a true foreign body present.  But they can get true obstructions – these are emergencies.  Your rabbit will be very sick and getting more sick very quickly.  Low body temperature is serious for both obstructions and more standard gut stasis.

What Can I Do?
Hind gut fermenters should never have an empty stomach – if there is any change in appetite or droppings start giving Critical Care until you can get to a vet.  The more abnormal your pet, the quicker you should get help.

What Does the Vet Do?
We may want to run some tests to better Guinea pig critical care feedingidentify your pet’s disease – radiographs and blood work can tell us a lot.  High blood glucose levels are actually more common in cases of obstruction.  The good news is that most of these animals can be managed with medical treatment such as Critical Care and fluids.  We will also consider if anti-gas medications, antibiotics or even medicines that promote motility should be used.

Can I Prevent Gut Stasis?
Yes…and no.  You can reduce the risks by feeding your pet a good quality grass hay with some leafy greens and a small amount of pellets.  Alfalfa hay has too much protein for regular bunnies, guinea pigs or chinchillas.  Lots of pellets means fewer long fibers that are so important to maintain normal gut movements.  A good healthy home environment can reduce stress as well.  Annual checkups with your vet are the best way to detect problems early and make sure problems you might not see (like dental disease) are identified as soon as possible.  Always brush your pet when they are shedding – if you have a long haired variety you’ll already be brushing very, very frequently just to keep the hair clean and prevent matts from forming.