Liver damage, fatty liver, liver inflammation

Diagram of the rabbit’s liver: On the left, the side adjacent to the diaphragm, and on the right, the side facing the abdominal cavity.

Liver damage often only becomes apparent at a late stage or goes unnoticed. Sometimes it is detected by chance through a blood test. The most common liver condition in rabbits is fatty liver disease (hepatic lipidosis), affecting more than half of all rabbits with liver issues. Far less common, but the second most frequent, are liver inflammations.

Symptoms are often rather nonspecific:

  • Weight loss, loss of appetite
  • Digestive disorders, bloating
  • Seizures
  • Obesity
  • Motor issues, unsteady or staggering gait, neurological symptoms
  • Sensitivity to light and temperature
  • Diarrhea
  • Yellowish skin tone
  • Dull fur
  • Sudden death

Diagnosis:

  • A blood test can be used to check liver values. Since liver values in rabbits often respond sluggishly, only specific markers, such as AST (most commonly elevated) or ALT, may show abnormalities. According to studies, alkaline phosphatase (AP) is not considered an indicator of liver disease in rabbits. Additional values that may indicate liver disease include GLDH (considered the most sensitive liver marker), GGT, bilirubin, triglycerides, and urea. Acute (GLDH without ALT) and chronic liver diseases (low blood protein levels, ALT) can be differentiated.

Trends for Specific Conditions:

Hepatic coccidiosis: Elevated ketone bodies, bile acids, cholesterol, triglycerides, bilirubin, anemia.
Fatty liver disease: Elevated triglycerides, cholesterol, and liver enzymes.
Traumatic hepatitis: Drastic increase in AST and ALT, sometimes accompanied by elevated kidney values.
Liver neoplasms and abscesses: Significant increase in liver enzymes, bilirubin, inorganic phosphate, and bile acids.
Infectious liver inflammation: Moderate, occasionally significant increase in liver enzymes, pseudoleft shift, leukocytosis, sometimes massive increases in urea and creatinine (kidney involvement).
Liver lobe torsion: Anemia, often with elevated ALT and AST.
Tularemia and rodentiosis: Pseudoleft shift, leukocytosis, often with no or minimal increase in liver values.
Heart disease/congestive liver: Liver values are only slightly elevated.
Poisoning: Elevated liver enzymes, bile acids, bilirubin.
Liver flukes: Anemia, hypoalbuminemia, elevated liver enzymes, and eosinophilia.

  • In nearly all cases, an ultrasound examination of the liver is crucial for an accurate diagnosis. Ultrasound allows differentiation between conditions such as hepatic coccidiosis, tumors, liver lobe torsion, liver inflammation, and liver trauma.

Causes of Liver Disease in Rabbits:

  1. Overfeeding with Rabbit Pellets:
    Overnutrition with commercial rabbit dry food can lead to fatty liver disease (hepatic lipidosis), which may cause sudden death.
  2. Reduced Food Intake or Anorexia:
    Refusal to eat or poor appetite leads to fat metabolism via the liver, potentially resulting in liver damage (fatty liver). This is why rabbits, especially overweight ones, should never fast. Conditions like dental problems or digestive disorders can also lead to reduced food intake and subsequent liver issues.
  3. Parasites and Infections:
    • E. cuniculi: Frequently implicated in liver disease, detectable through blood tests measuring IgG and IgM titers to determine activity. However, high titers may also appear in weakened rabbits as a secondary infection.
    • Syphilis: Diagnosed via a specialized blood test, though the process is lengthy. Monitoring symptoms is crucial.
    • Liver flukes: More common in rabbits fed grass from damp pastures shared with cattle, horses, or sheep.
    • Coccidiosis: Parasites often detectable in feces, though liver-specific cases may not show in fecal tests, necessitating ultrasound for confirmation.
    • Rodentiosis (Pseudotuberculosis): Rare, but may cause liver issues, chronic weight loss, and occasional fever spikes.
    • RHD(2): Chronic forms of Rabbit Hemorrhagic Disease, even in vaccinated rabbits, are possible.
    • Tularemia: Rare, affecting the liver in either acute or chronic forms.
  4. Mycotoxins and Mold Toxins:
    Contaminated feed or hay containing mold toxins can damage the liver.
  5. Hepatitis:
    Inflammation of the liver is rare but often occurs alongside systemic infections, with symptoms like anorexia and lethargy.
  6. Congestive Liver (Heart Disease):
    Heart disease can cause blood congestion, leading to liver damage. These rabbits often exhibit signs of heart issues.
  7. Traumatic Liver Injury:
    Accidents, such as falls or being accidentally stepped on, can result in liver trauma. Affected rabbits appear apathetic, lethargic, and may huddle with half-closed eyes.
  8. Liver Lobe Torsion:
    A rare but serious condition, especially in white lop-eared rabbits with brown spots. It can only be detected via ultrasound, is often overlooked, and can be fatal. Symptoms may include recurring gastric dilatation (bloating).
  9. Liver Tumors and Abscesses:
    Liver tumors, including malignant lymphomas and metastases, as well as abscesses, are possible causes of liver disease.
  10. Toxins and Medications:
    Liver damage can result from consuming toxic substances, poisonous plants, or medication. While rare, poisoning by plants like autumn crocus (Colchicum autumnale) is the most likely culprit.

Proper diagnostics, including blood tests and ultrasound, are essential to determine the exact cause and appropriate treatment for liver disease in rabbits.

Treatment:

Caution! Do not use products containing added amino acids! The methionine present in such products can worsen liver function in rabbits. S-Adenosyl-L-Methionine (SAMe) is included in some preparations for dogs and cats, but it should be avoided in rabbits.

Treatment for Liver Disease in Rabbits:

  1. Identify and Address the Underlying Cause:
    The first step is to determine and eliminate the cause of the liver disease (e.g., treating coccidia, syphilis, E. cuniculi, or managing overweight rabbits through a controlled weight loss plan).
  2. Infusions:
    Intravenous fluids are crucial for recovery. Your veterinarian can demonstrate how to administer them. The preferred infusion is a full-electrolyte solution (e.g., Jonosteril, or Ringer’s solution without lactate).
  3. Liver Protection Supplements:
    • Rodicare Hepato, Toxisan, and other liver support products can be used.
    • Milk Thistle Extract: This can help detoxify the liver. Capsules should be opened, and half the contents can be administered daily. Milk thistle seeds are also excellent as rabbits often eat them directly.
  4. Lactulose:
    Lactulose (e.g., AA Laxulon, Laxatract) is sugar-free and helps create an acidic environment in the intestines. This can bind and convert toxic substances (like ammonia) into ammonium, which is then excreted through the stool. This can be given 2-3 times daily (2-3 ml per kg of body weight).
    • Apple pectin and inulin (from Jerusalem artichokes, chicory) also have similar effects.
  5. Multivitamins for Rabbits:
    A specific multivitamin supplement for rabbits should be used, especially those rich in antioxidants like vitamin E, vitamin C, and B vitamins.
  6. Herbs and Natural Remedies:
    • Black Cumin Seed Oil (Nigella sativa) in low doses can be beneficial for the liver.
    • Selenium and zinc can also support liver health.
    • Omega-3 fatty acids (EPA and DHA) can reduce inflammation, oxidative stress, and liver damage. Algae oil is a good supplement for these nutrients.
  7. Dietary Changes:
    All commercial pellet foods should be immediately removed from the diet and replaced with fresh, varied greens. This will help reduce the burden on the liver. Fresh food and a reduction in dry foods can significantly support liver function.
  8. Detoxifying Herbs:
    Many herbs can support liver detoxification and improve liver metabolism, including:
    • Milk Thistle, Walnut leaves, Dandelion, Cumin, Birch leaves, Yellow Root (Curcuma), Licorice, Lady’s Bedstraw, Raspberry leaves, Artichoke leaves, Garlic greens, Gentian root, Yarrow, Rosemary, Thyme, Ginger, Schisandra, Nettle, Beetroot, Cabbage, Fennel, Carrot… Bitter plants, in general, are especially beneficial for stimulating and regulating liver metabolism.
  9. Hydration:
    Encourage your rabbit to drink more by using a bowl instead of a nipple waterer. Sometimes offering carrot juice can help increase water intake.
  10. Medication Considerations:
    Medications for other diseases should be avoided, especially those metabolized by the liver.
  11. Complex Homeopathic Remedies:
    Certain complex remedies from Heel (e.g., Hepar compositum, Cerebrum compositum) can be used for liver treatment, depending on the specific liver disease. These can also be mixed with the infusion fluids. However, the efficacy of homeopathic treatments is not scientifically proven.
  12. Surgical Intervention:
    In cases of liver lobe torsion or liver tumors, surgery may be required.
  13. Infectious Liver Diseases:
    For infections such as rodentiosis or tularemia, antibiotics will be necessary. Infectious liver inflammation should also be managed with liver-friendly pain relief (e.g., Metamizole (Novalgin)) alongside intensive therapy.
  14. Supportive Feeding:
    If the rabbit refuses to eat, it must be hand-fed to prevent further complications from malnutrition.
Medicinal PlantImportant ComponentsEffectUses/Indications
Artichoke LeavesBitter substances, flavonoids, hydroxycinnamic acidsStimulates bile flow, stimulates digestive juicesDigestive disorders, fat metabolism, lipid metabolism disorders
GentianEssential oils, bitter substancesAppetite stimulant, decongestant, increases bile secretionLoss of appetite, digestive disorders (colic, bloating, flatulence), stimulates bile flow
TurmericBitter substances, essential oils, curcuminStimulates bile flowDigestive disorders, liver and gallbladder diseases
DandelionBitter substances, triterpenes, flavonoids, phytosterolsStimulates bile flow, increases gastric juice secretion, anti-inflammatory, stimulates metabolism, antispasmodicDigestive disorders, loss of appetite
Milk Thistle (Seeds)Bitter substances, flavonoids, silymarin complexProtects and heals the liver, stimulates metabolismAcute and chronic toxic liver diseases, digestive disorders
PeppermintEssential oil (especially menthol), tannins, flavonoidsAntispasmodic, antiflatulent, stimulates bile flowDigestive disorders, relieves flatulence and bloating
WormwoodEssential oils, bitter substancesAppetite stimulant, decongestant, stimulates bile flowLoss of appetite, digestive disorders (colic, bloating, flatulence), stimulates bile flow

The liver is capable of regeneration, provided that the underlying cause is promptly addressed.

Case Studies on Liver Health in Rabbits: Diagnosis, Treatment, and Recovery

Case Study 1: Schnuffel, 8-9 years old, EC-positive, fed with fresh greens

  • Initial condition: Schnuffel received a full-electrolyte solution, Silicur, Hepar comp., and milk thistle seeds.
  • Diagnostic results: Fecal examination and ultrasound showed no abnormalities.
  • Outcome: Five days after the first blood test, liver values returned to normal.

Case Study 2: Mixed breed rabbit, 5 years old, incidental finding of poor liver values in blood test

  • Treatment: Administered black cumin oil, Gladiator Plus, and milk thistle extract once a day. A homeopathic therapy with Hepar comp. and Cerebrum compositum was also used.
  • Diet: Detoxifying plants were included in the diet.
  • Outcome: A follow-up blood test after two weeks showed no abnormalities.

Case Study 3: Leon, 6 years old, apathetic behavior, poor appetite, rough coat, slight head tilt, EC-positive, elevated liver values

  • Symptoms: Leon exhibited a lack of appetite, dull fur, and a slight head tilt.
  • Treatment: The rabbit was treated with Panacur, Hepar comp., infusions, and milk thistle extract.
  • Outcome: Full recovery after three weeks.

These case studies highlight the importance of early detection, appropriate treatment, and monitoring of liver health in rabbits. They also show that with the right interventions, the liver can recover even from elevated liver values or infections such as EC (Encephalitozoon Cuniculi).

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