Liver Disease

[KrisandOz]

Hi first time poster long time rabbit parent! My girl Ozzy who is 13 went completely anorexic a day and a half ago. I immediately went to the vet ( not my normal only ER was open as it was after hours) she checked her teeth which were ok palpated and found no sensitivity, gas, or bloating. So we pulled blood and it came back that her liver enzymes were elevated, moderately elevated ALT and ALKP proteins, mild increase in calcium, slightly hypoglycemic. She then wanted to do further diagnostic such as sedate and ultrasound and possibly biopsy. I opted not to at that point in time because I feared with her age sedation is not really possible. We have her subQ fluids and was sent home with critical care, and antibiotic enrofloxacin for what could be a possible infection causing the liver elevations, and thankfully metacam b/c at first she wasn’t going to give it to me and only gave me 3 syringes of 0.12mL to give every 24hrs if I felt she needed it. I was left with the unclear diagnosis of it could be fatty liver disease do to the elevated liver enzyme and ALT, the calcium level suggest it could be cancer, or possibly an infection of some sort. Her normal diet consist of free choice oxbow Timothy hay about 1/10 cup of oxbow pellets, fresh veggies, and a sprinkle of alfalfa in a box full of shredded paper to dig it out and keep her active. Up until the vets visit she had started to have more and more cecotropes that were quiet unformed and smelly so I was reducing the leafy greens and pellets slightly but did not help change the poops. Now she’s very lethargic and is sleeping a lot more then usual but doesn’t seem like she’s in distress and uncomfortable be she’s been sleeping to the point of snoring, but she is still only nibbling hay mostly the alfalfa at this point will eat a one or 2 pieces of veggies every couple of hours or so. She has veggies and fresh Timothy hay sprinkled with alfalfa crumbs to entice her in everyone of her sleeping spots and has been urinating and pooping every 4 to 6 hours or so. When I first brought her home she had those soft smelly stools for about 6-10 hours but now they she has had nice normal looking pellets. I am feeding her the critical care every 4-6 hours but it stresses her out immensely. I am on the fence that she is partially not eating bc I have to now keep stressing her out to syringe feed her but I am afraid of her not eating enough or getting enough fluids if I don’t. Does anyone have any sort of experience or suggestions I feel at a loss as I just moved and don’t have her vet that’s known her all her life. I have a recommended day vet but we haven’t met them yet. I’m so tossed and turn about if i should keep force feeding as she gets upset and will sometimes seem to start shaking after fighting the syringe, also if I should bring her back to the day vet Monday if shes still not back to eating fully on her own even though trips to the vet she normally is quiet and won’t eat for a couple hours after? I just feel so bad for her to see her sleeping all the time as for her age she is still pretty active. Any info or ideas suggestions thoughts would be greatly appreciated!
Thanks in advance !

[BarbaraC]

Hi KrisandOz. Was her temp normal? If it was an infection I would think that her temperature would be elevated. Given your Ozzy’s age did the vet indicate that this could just be her organs failing due to old age?

Another cause of elevated liver enzymes could be liver torsion. This would also explain the loss of interest in eating. Liver torsion is fairly rare and many vets are not familiar with it and the only definitive way to diagnose it is with an ultrasound. The only treatments for it are either surgery or supportive care of pain meds and critical care. Given her age it sounds like you made the right choice in not doing the ultrasound and for the same reason surgery would probably not be a good option either. The surgery involves removing the twisted lobe. By giving supportive care you hope to keep her healthy enough to allow the lobe to scar over and shrivel on its own. If the lobe untwists before this can happen it will release toxins into her system that will cause her to go into septic shock and death will follow quickly afterwards. If this is liver torsion, the process of the liver scarring over should take about a week, after that she would be considered out of the woods. Also, the Metacam can cause lethargy.

I have personal experience with this and opted to not go the surgical route even though my bunny is only 2-5 years old. The surgery itself has its own risks and does not necessarily guarantee a positive outcome.

I hope this information helps and that Ozzy can pull through this.

[ergodic]

Liver problems can sometimes be a secondary issue. Especially if she was not getting the nutrients. George had issues with his liver count during his ulcer period. Calcium is really tricky with rabbits they have very unique metabolism with respect to calcium. Does she need to be sedated for the ultrasound? How was her red blood cells?

[KrisandOz]

Red blood count was normal thankfully. The vet that I had went to had said that she sedates to get a better image and then she can also biopsy if needed, but idk for a rabbit her age I feel like that’s too invasive. I would be fine if she was just willing to ultrasound without sedation. What did you do for George’s ulcers if you don’t mind me asking?

[KrisandOz]

Thanks Barbara! Her temp was 100.6 which is pretty low but it was also a 5 second instant thermometer so it might have not been that accurate. I appreciate the info on liver torsion! I have never heard of that in rabbits. I wasn’t that pleased with the vet bc she kept pushing the ultrasound and sedation and when I asked if this could just be Ozzy getting old and it’s more a degenerative thing she never really answered. They did not want to give me the pain meds at first either. Supportive care has been rather difficult as now Ozzy wants no park of being syringe fed and biting and squirming have become an issue. Poor thing is so stressed that I almost want to give her a couple of hours with the pain meds to see if her appetite increases more then just a few bites of hay and carrot tops.

[ergodic]

George had his ultra sound while he was still conscious. It went okay. I had asked for the ultra sound simply to ensure that there was no coccidia or tumor since George appeared to had liver failure as well.

The syringe is really not that bad after you get used to it. I have to give my one bun it 3 times a day. He has gotten quite used to it by now. The trick is using the one hand to control the head and use other other to get the syringe in.

Normally a torsion would cause a lot of pain so she would probably be grinding her teeth.

[BarbaraC]

With liver torsion there would also be tenderness in her abdomen up near the rib cage. It is very rarely diagnosed so many vets are not familiar with it. How often it actually occurs and is just not diagnosed is unknown.

The low temp could be caused by the sress of the car ride. Whatever the cause, a low temp does not typically indicate an infection but does put the bunny at risk of going into shock. A few different vets have mentioned to me that a low temp is more common in rabbits than a high one and can be just as dangerous.

You’re right to think that this could just be her getting older and her organs are not functioning as well as they used to. 13 is a long life for a bunny.

It sounds like you are doing everything you can for her and hopefully the syringe feeding will get easier. Sometimes I think its even more stressful for the humans than the bunnies.

[BarbaraC]

P.S. Never be afraid to get a second opinion. Especially if you aren’t confident that what your vet is telling you makes sense.

[KrisandOz]

Yes I’m hoping my regular office is open tomorrow even though it’s Labor Day if not I can take her to the vet school that’s in my area. So far she’s still nibbling on hay and sometimes a carrot top stalk or two. So we are going to hopefully keep fighting through the syringe feeding battle to keep her going! Thanks everyone!

[jerseygirl]

and thankfully metacam b/c at first she wasn’t going to give it to me and only gave me 3 syringes of 0.12mL to give every 24hrs if I felt she needed it.

Good for you to request metacam!

The raised liver enzymes and low blood glucose may be direct result of her not eating, rather then the cause. Fatty liver disease in rabbits is also usually associated with the anorexia. So again, direct result of not eating, This can be detected through urine test if there’s an onset.

Does anyone have any sort of experience or suggestions I feel at a loss as I just moved and don’t have her vet that’s known her all her life.

If you feel comfortable with posting where you are now located, some BB members may be able to recommend a good rabbit vet for you.

Healing (((vibes))) for you girl.

[KrisandOz]

Update! Someone reccomdended avian & exotics vet in Raleigh NC and they were wonderful. The exotics vet wasn’t overly concerned with the elevated liver unlike the ER vet so we gave her more fluids and found a flavor of critical care that Ozzy would tolerate and after 3 good meals she’s back to her normal self poop and all (: thank you everyone for the advice and support and if anyone in the area needs a good rabbit savvy vet avian & exotics in Raleigh is fantastic and they only do exotics so it’s nice not to have dogs barking at your rabbit in the waiting room!

[jerseygirl]

Great to read this.

Happy to read you’ve found a vet too!

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