Clinical examination of the rabbit

Reasons for an urgent examination

• Anorexia lasting over 12 hours.
• Evident state of malaise, immobility, lack of interest for the surrounding environment.
• Difficulty in breathing (open mouth breathing is an emergency).
• Diarrhoea.
• Injuries or trauma (falls, attacks).
• Bleeding from the vulva.
• Repeated attempts to urinate.
• Perineum soiled with urine or faeces.

Suggestions for hospitalization

If hospitalization of the rabbit is planned, ask the owner to bring the following items:

•  A stock of the animal’s favourite food, both dry and fresh, and of the hay regularly used.
•  The cage, if spacious enough but still portable.
•  The usual food and water containers.
•  The litter box and the material used to fill it.
•  If the rabbit has a companion, it may be desirable to keep them together in order to facilitate   recovery and decrease stress.

RESTRAINT

Proper restraint is necessary to prevent injuries to the rabbit. In addition, showing the owner that we know how to handle her/his pet with confidence, sensitivity and skill strengthens the owner’s confidence in our ability as veterinary surgeons: handling of the rabbit in a clumsy or abrupt way could make the owner decide to change vet. In order to prevent injuries, particularly recalcitrant or frightened subjects should rather be sedated than restrained with an excessive use of strength.

Rabbits should never be held by the ears; not only does this cause pain and fear, but it will also generate negative feelings in the owner.

There are several ways to handle a rabbit safely; in all cases the grip must be delicate, in order not to hurt the animal, but firm, to prevent it from escaping from your hands with a sudden movement. Rabbits can be lifted up and carried around by supporting their body with one arm and immobilizing their front limbs with one hand, while the other covers the eyes to calm it down (Fig. 5); another possibility is to tuck the rabbit’s head under your arm to prevent it from seeing (Fig. 6). Wrapping the rabbit in a towel is another way to restrain the animal and to calm it down at the same time (Fig. 7).

To examine the ventral region, the limb extremities and the perineum, the so-called "C-grip" is used. One hand supports the hindquarters, the other restrains the front limbs and the body of the rabbit is placed against the chest of the operator (Figs. 8 and 9). This grip is useful for assessing the sex of baby rabbits and for cutting nails, when someone is available to help.

During the examination the patient should be placed on a non-slip surface (like a big towel or a rubber mat) (Fig. 10): if the rabbit feels that it is slipping it may get agitated and injure itself. An appropriate restraint for performing subcutaneous injections consists in covering the animal’s eyes with one hand and putting the other hand on its back, so that the animal cannot move backwards (Fig. 11). To perform intramuscular injections at the level of the lumbar muscles it is advisable to wrap the animal in a towel, leaving only the lumbar area exposed.

A gentle grip is always necessary, in order to immobilize the rabbit and to prevent falls from the table. Only experienced and reliable owners can be asked to personally monitor and restrain the animal on the examination table.

Rabbits that are very frightened and prone to escape by jumping off the table must be examined on the floor, with the vet squatting on the ground.

CLINICAL HISTORY

As with more traditional species, the clinical history is a key element in the assessment of the rabbit patient; if carried out properly and thoroughly, it can often give some first accurate indications about the cause of the problem. Moreover, the clinical history can highlight possible (very frequent) mistakes in the management of the animal, on which the owner must be properly educated. For a proper collection of the clinical history the veterinary surgeon should listen carefully to the owner’s observations on the health and behaviour of the rabbit: an attentive and loving owner can catch subtle changes which are very useful for the clinician. On the other hand, there are also careless or unprepared owners who absolutely fail to understand obvious signs of serious illness.

Origin. Rabbits coming from shops, breeders and street markets have a high incidence of ectoparasites, dermatophytosis, coccidiosis and bacterial respiratory infections. They are often sold when still too young and not properly weaned and are prone to serious digestive problems.

Age. Young rabbits are particularly subject to develop intestinal disorders (often severe) during weaning and the transition to a solid diet, and to suffer injuries from falls which occur when living with small children. Older rabbits may have degenerative bone and joint problems. Acquired malocclusion usually occurs after 3 years of age. Neoplasms can be more frequent in older rabbits, bur in general they are uncommon.

Gender and possible neutering/spaying. The gender, especially in young subjects, should be checked during the visit, because the owner is often unaware of the sex or it has been identified incorrectly. Intact female rabbits are at risk for uterine carcinomas and for other reproductive disorders. Intact adult male rabbits may develop behavioural problems such as aggressiveness and faecal and urine marking.

Vaccination status. Rabbits are at risk for two important viral diseases: myxomatosis and VHD (viral haemorrhagic disease); the two diseases are lethal and rabbits must be regularly vaccinated against them.

Management. Continuous confinement in a cage is not appropriate, but when left out the rabbit should be in a safe place and under supervision. The owner should be educated to make the house "rabbit-proof", eliminating potential hazards and preventing any possible damage that the animal might cause. The cage must be adequately spacious and with a substrate suitable for the feet of animal. Rabbits continuously confined in a cage may be prone to pododermatitis, obesity, intestinal stasis and hypercalciuria.

Diet. One cannot emphasize enough the importance of a proper diet for the health of the rabbit. The diet used should be carefully investigated, not only the current one, but also the ones of previous years, as rabbit dental diseases can be caused by long-standing dietary mistakes. It is also necessary to understand if the pet receives any treats, such as biscuits and the like, even if occasionally.

In addition to dental diseases (malocclusion, dental abscesses), a wrong diet can cause gastrointestinal stasis, altered caecotrophy, obesity (and correlated disorders), hypercalciuria and secondary perineal dermatitis.

Appetite. Rabbits eat for most of the day. A 12-hour anorexia is indicative of a problem; after 24 hours an immediate investigation is necessary. After 48 hours complications related to hepatic lipidosis may already be present. In the case of symptomatic malocclusion despite not eating the rabbit is often hungry, showing interest in food even if it is not able to swallow it. In the presence of gastrointestinal stasis the animal is instead uninterested in food. This can be a useful cue when the patient is not eating. 

Thirst. Rabbits that eat a lot of fresh food rarely drink. An increase in thirst may be related to renal failure, but also to a decreased appetite: rabbits that eat less often compensate for water needs by drinking more.

Faeces. The production of faeces, their quantity and texture is a very useful health status indicator. Normal rabbits produce around 150 faecal pellets per day, round and dry, composed of fibre (Fig. 12). The lack of faecal production is indicative of the presence of GI stasis (primary or secondary). Droppings smaller in size and irregular in shape are often observed at the beginning of a stasis episode or during its resolution (Fig. 13). The production of  "chain-shaped" or cord-like droppings may be due to the ingestion of hair (Fig. 14), especially during moulting in long-haired rabbits, or to the presence of very long fibres, caused by inadequate chewing consequent to occlusal plane alterations (malocclusion) (Figs. 15-16). Differentiation between the two conditions is possible by dissolving the faeces in water and checking for the presence of hair or vegetable fibres. Caecotropes are not usually seen as they are ingested although occasionally they can be found on the floor (Figs. 17-18); they consist of shiny little roundish pellets, covered with mucus and with a pungent sour smell. Diarrhoea must be differentiated from the production of caecotropes. In the presence of diarrhoea (Fig. 19), the production of faecal pellets is completely absent and the animal often shows signs of depression. When the caecotropes being produced are abnormal (Figs. 20-21) and are not ingested, the rabbit may still continue with the normal production of faeces without showing general signs of malaise; this condition is usually caused by fibre deficiency.

Urine.The urine of rabbits is usually very turbid due to the presence of abundant calcium crystals (Figs. 22-23). The normal colour varies from yellow to cream, from pink-orange or red to brown, due to the presence of vegetable pigments (Fig. 24). When turning to red the colour may be misleading for the inexperienced owner, but it is reasonable to exclude the presence of a real haematuria (Fig. 25), which would be indicative of urogenital problems (especially involving the uterus).

Urination (frequency, urine amount and consistency, inappropriate urination). Urination abnormalities can be caused by urinary tract disorders as well as by musculoskeletal or nervous system conditions. Inappropriate urination can be a behavioural problem related to marking.

Vivacity. A reduction in liveliness is almost always a sign of disease. With the passing of the years a progressive decrease in the physical activity of the animal is physiological.

Unusual/different behaviours. A change in eating or voiding habits, or in behaviour (aggressiveness, tendency to hide) may be indicative of some health problem.

Previous health problems. The owner should be asked if the rabbit suffered previous health problems, how they manifested themselves, what treatments were used and what was the outcome.

Reason for the examination. It is always necessary to ask when the problem started and how it manifested itself, how it evolved, the eventual therapies already tried and the outcome. The administration of enterotoxic antibodies may cause intestinal dysbiosis and, consequently, enteritis. Corticosteroids, even if administered for short periods of time or applied topically, can trigger severe immunodepression.

Other relevant information. The owner should be encouraged to report any additional information that she/he considers useful and which has not been asked for explicitly. Some particularly attentive owners may notice physical or behavioural abnormalities that are missed during the routine examination.

PHYSICAL EXAMINATION

The examination must always be extensive and accurate, even if the cause of the condition may appear obvious. In order to avoid overlooking important elements a systematic approach should be followed.

Before handling the rabbit, the patient should be examined in the carrier or cage, assessing the respiration, mentation and focusing on abnormal behaviours that may then be masked by the rabbit during the physical examination. An increased respiratory rate may have physiological (fear, heat) or pathological (cardiac, pulmonary or intrathoracic diseases) causes. In the presence of a disease, slow, deep breaths may also be present.

Subjects with severe respiratory impairment should be handled with extreme care so as not to trigger a respiratory crisis. In such cases oxygen may be administered and the rabbit should be stabilized before starting with the examination.

In view of the small size of the rabbit and the high heart and respiratory rate, thoracic auscultation is not easy to interpret. A paediatric stethoscope should be used, with a small head, with auscultation of both the right and left heart. Auscultation of both pulmonary fields is necessary. The presence of abnormal pulmonary sounds or the absence of any sound may be due to pneumonia, mediastinal masses, pulmonary abscesses or neoplasms. Most pulmonary tumours are metastatic uterine carcinomas.

The body condition is assessed with a scale ranging from 1 to 5, to be interpreted as follows: 1 = very thin, 2 = thin, 3 = normal, 4 = fat, 5 = obese.

• Score 1: Very thin (Figs. 26-27). Hip bones, ribs and spine are very sharp to the touch. Loss of muscle and no fat cover. The rump area curves in.
•  Score 2: Thin. Hip bones, ribs and spine are easily felt. Loss of muscle and very little fat cover. The rump area is flat.
•  Score 3: Ideal (Fig. 28). Hip bones, ribs and spine are easily felt but are rounded, not sharp. The abdomen and the skin of the neck do not bulge. The rump area is flat.
•  Score 4: Fat. Pressure is needed to feel the hip bones, ribs and spine because of the thick fat layers. The abdomen and the skin of the neck bulge slightly.
•  Score 5: Obese (Figs. 29-30). The ribs cannot be felt, it is very hard to feel the hip bones and the spine because of the thick fat layers. The abdomen and the skin of the neck bulge out.

Rabbits tend to accumulate fat predominantly at visceral level and only very fat subjects have an evident subcutaneous panniculus. The thinness of the animal may be masked by the fur and owners are often not aware of a possible state of cachexia. Recording the weight of the rabbit at each visit is important in order to monitor any possible change over time.

Nostrils must be clean and without crusting or discharge (Fig. 31). Being the rabbit an obligate nasal breather, an infection of the nasal airways can have serious health implications. Nasal discharge can be unilateral or bilateral (Fig. 32). Rabbits wipe their nose with the front legs: even if the nostrils appear clean, the presence of wet matted fur on the front limbs (the handkerchief sign) may be indicative of rhinitis (Fig. 33).

The skin of the nose and lips can host Treponema paraluiscuniculi (rabbit syphilis) infections that are characterized by crusted-ulcerative lesions, dermatophytosis (Fig. 34) (with the formation of alopecic scaling erythematous lesions) and sarcoptic mange (Fig. 35), which causes the production of thick crusts.

The eyes must be clean and without discharge (Fig. 36). The eyelids can be affected by dermatophytosis or sarcoptic mange (Fig. 37). In the presence of myxomatosis, eyelids present nodules and tumefactions with purulent discharge often so severe as to prevent the animal from opening them. Infrequent congenital defects are ectropion and entropion, even in combination (Fig. 38).

Epiphora can be caused by conjunctivitis or more often by the obstruction of the nasolacrimal duct due to infections or dental disease (Fig. 39). Secondary to epiphora are wet and stained fur, alopecia, erythema and even the formation of extensive erosive and crusted lesions on the face (Fig. 40). The lacrimal point (only the inferior one is present in the rabbit) is on the conjunctiva of the lower eyelid, near the medial canthus; it can be observed by gently pulling the eyelid to the side (Fig. 41). Shape-wise, it is like a small “V-shaped” incision.

A slight pressure on the eyeball allows the protrusion of the third eyelid. During the breeding season intact males exhibit a hormone-based hypertrophy of the Harderian gland, which gives the third eyelid a more intense and more prominent pink colour. The Harderian gland may prolapse or develop neoplasms.

The conjunctiva and the sclera can be examined by gently lifting the eyelids (Fig. 42). In case of inflammation the mucosa may appear heavily congested (Fig. 43). The cornea must be perfectly transparent. In the course of keratitis a clouding of the cornea with blueish discoloration and the formation of newly formed scleral vessels may develop. Abscesses, so-called stromal abscesses, which appear as whitish or yellow lesions, may develop within the thickness of the cornea (Fig. 44). Iris heterochromia is a common finding (Fig. 39). The most frequent cause of uveitis is the rupture of the crystalline lens secondary to uterine E. cuniculi infection (Fig. 45).

Unilateral or bilateral cataract (Figs. 46-47) may be caused by age-related alterations or by E. cuniculi infections. Cataract is not instead linked to diabetes, which is extremely rare in the rabbit.

Looking at the head in a frontal view the eyes should be symmetrical. A unilateral exophthalmos can be predictive of a retrobulbar abscess secondary to malocclusion or more rarely of a tumour. Bilateral exophthalmos is usually secondary to the presence of a mediastinal mass (thymoma or lymphoma) that, by blocking the venous return to the heart, causes dilation of the periorbital vessels (Fig. 48).

The incisor teeth can be examined by moving the lips to one side (Figs. 49-50). They must be straight and regular, with smooth and uniform enamel. A physiological dark coloration may result from the grass and vegetable diet. The large upper incisor teeth present a longitudinal groove all along the entire labial surface, groove which is instead absent in the lower teeth. The teeth ends must be sharp and the bite horizontal. The auxiliary incisor teeth are round in section, small in size and located directly behind the large top incisors. The bottom incisors must lock against the fissure formed between the large upper incisors and the small auxiliary incisor teeth. The presence of transverse lines is indicative of enamel dystrophy secondary to infections or food deficiencies. An oblique bite (Fig. 51), be it irregular or flat (Fig. 52), indicates the presence of malocclusion. One or more incisors may be absent due to injuries (Fig. 53) or infections. In case of malocclusion of the incisors (Figs. 54-55) these are not worn down correctly and grow indefinitely, injuring the soft tissues of the mouth. Malocclusion of the incisor teeth can be primary (congenital) or secondary to trauma or infections or to malocclusion of the molar teeth. The presence of perfect incisors does not rule out the possible presence of molar teeth abnormalities, even severe ones.

The mucous membranes must be pink in colour. Blueish mucous membranes indicate the presence of severe respiratory failure. Pallor may be associated with anaemia (Fig. 56) or shock. In mature or elderly intact females the main cause of anaemia is represented by uterine abnormalities with chronic bleeding.

The inferior mandibular margin must be smooth; swellings are a sign of dental abscesses (Fig. 57) or of excessively long roots due to malocclusion. Face palpation should not cause pain or reveal the presence of swellings or nodules, which may be indicative of the presence of dental abscesses and osteomyelitis (Fig. 58). The skin of the chin and throat must be dry. The presence of sialorrhoea (and, secondarily, of moist dermatitis) is almost always indicative of symptomatic malocclusion  (Fig. 59).

The ears can be erect or, in lop-eared breeds, pendulous (Fig. 60). The pinnae can be affected by dermatophytosis (Fig. 61) or sarcoptic mange. When myxomatosis occurs, characteristic nodular lesions and plaques of thickened skin are present (Fig. 62). After the initial external ear inspection the ear canal is examined with the otoscope. A certain amount of clear cerumen may be present within the ear canal. The presence of pus is a sign of infection. If psoroptic mange is present (Fig. 63) the ear canal fills with thick crusts that, over time, extend to the head and to the rest of the body. The ears are subject to injuries (Fig. 64) (e.g., rabbit bites, dog attacks), otohaematoma (Fig. 65) and rarely tumours (Fig. 66). Congenital auricular agenesis may be present (Fig. 67).

The fur must be clean, shiny and regular (Figs. 68-69). The body is completely covered with fur, except for the inner part of the pinnae and the scrotum, where hairs are very sparse. Normally, an area of alopecia or thinning of the fur is visible along the nape area (Fig. 70), more accentuated during moulting. In long-furred rabbits, such as in the Angora, the fur tends to form knots and becomes matted if not brushed daily. Moulting takes place by discrete areas and propagates in craniocaudal direction. During shedding it is therefore normal to have a clear demarcation between newly growing hair and the old fur, which can easily be removed in hair tufts (Figs. 71-72). Areas of alopecia with intact skin may be present in some subjects before the growth of the new hair.

The presence of skin desquamation, detectable especially on the rump (Fig.73), can be caused by Cheyletiella spp. infestations. Another parasite which can be found on the fur, adhering to the hair shaft, barely visible to the eye, is the acarus Listrophorus (Leporacarus) gibbus. Flea droppings may be detected by sieving through the fur on the rear part of the body. Running the hands along the rabbit’s body no lumps or swellings, mainly caused by subcutaneous abscesses, should be felt (Fig. 74). Skin cancers are not very common. Subcutaneous oedemas, a rare finding, may be caused by heart or renal failure. Diffuse blood extravasation may be secondary to anticoagulant poisoning (Fig. 75), in any case a rare event.

The front paws of the rabbit have five toes and the hind feet four; the claws are non-retractable and grow continuously, they can be lightly coloured or pigmented (Fig. 76). Excessively long nails (Fig. 77) must be trimmed to prevent them from tearing or from distorting the anatomy of the toes. Rabbit toes may be affected by dermatophytosis (Fig. 78) or sarcoptic mange (Fig. 79), with lesions that may initially remain invisible under the fur. The under surface of the paws is covered with fur and rabbits do not have foot pads. If the animal is not well managed (floor which is too hard or abrasive, or dirty and damp), alopecia, erythema, ulceration, crusts and pus (pododermatitis) may be observed (Figs. 80-81). In more severe cases the paws may appear grossly deformed due to propagation of the infection to the bone tissue; in such cases the infection can then extend to the entire limb, involving all bone segments.

The perineal area must be clean, with no signs of alopecia and inflammation (Figs. 82-85). In both sexes the inguinal glands, two cutaneous pouches which may contain a small amount of brown cerumen, are adjacent to the genital orifices (Fig. 85). Dermatitis may be present in the perineal area (Figs. 86-87), which may be secondary to intestinal disorders (abnormal caecotrope which remains adherent to the skin causing inflammation), urinary disorders (hypercalciuria and consequent inappropriate urination, with urine soiling) and neurological/orthopaedic conditions (inability to assume an appropriate position when urinating, again with urine soiling). During the hot season perineal dermatitis can be rapidly exacerbated by the presence of myiasis (Fig. 88).

In intact males it is not uncommon to find a bladder herniation into one of the scrotal sacs (Fig. 89), presenting itself as a fluctuating, painless enlargement of the sac. Again in intact males, traumatic scrotal lesions can be found in subjects living together with other intact males, resulting from bites caused by fights (Fig. 90).

The testes may be the site of unilateral or bilateral neoplasms, with consequent increased testicular volume and the presence of shape irregularities (Figs. 91-92). Testicular abscesses, painful on palpation, are a rarer finding. Unilateral or bilateral cryptorchidism is quite uncommon; in non-sterilized rabbits it may be differentiated from temporary abdominal testicular retraction by the absence of the scrotal sac. Papillomas, at times haemorrhagic, may at times be present around the anus (Fig. 93).

Palpation of the abdomen should be done gently and should not cause pain or eventually cause visceral disruption. When palpating the abdominal organs it is normal for the rabbit to show signs of discomfort, but a pain reaction is not normal.

The stomach is usually soft and easily compressible. In the presence of gastrointestinal stasis it may appear dilated or dense in content. The spleen is very small and is not palpable; in the rabbit spleen disorders are very rare. Kidneys are very mobile and relatively ventral, especially if a thick layer of sublumbar adipose tissue is present.

 
The caecum, which occupies most of the abdominal volume, is soft. In case of caecal constipation its content can be very dense. If meteorism is present, abdominal palpation can evoke a gurgling sensation or the presence of gas.

The bladder can be felt in the posterior part of the abdomen; bladder palpation should be particularly gentle as in the presence of urethral obstruction caused by stones an improper handling can result in bladder rupture. In case of hypercalciuria the presence of a dense mass can be detected.

A normal uterus is small in size and not palpable, unless a particularly abundant infiltration of fat in the mesometrium is present, as happens in very fat female rabbits. In mature and elderly female rabbits an increased uterine volume is a common finding. The most common cause is uterine carcinoma, however mucometra and pyometra are other possible causes. A gravid uterus is detectable starting from the 20th-22nd day of pregnancy.

In case of bladder disorders (cystitis, hypercalciuria) a gentle compression of the bladder easily allows to obtain some urine output, something which normally does not happen. In rabbits with hypercalciuria, urine may be of semi-solid consistency due to the abundant presence of calcium (Fig. 94).

In intact females the mammary glands can be of increased volume during pseudopregnancy or in the presence of cystic alterations or neoplasms (relatively rare and often related to uterine disorders).

Palpation of the limbs is necessary in order to assess muscle development and the possible presence of swellings (abscesses, tumours) or fistulae (Figs. 95-96).

The neurological examination is difficult in view of poor patient collaboration, with the rabbit remaining rigid in conditions of fear and stress. In the rabbit the menace response is absent.

The rabbit can be put on the floor, which has previously been covered with non-slip material such as a large towel, in order to examine how it moves. A rabbit with normal mentation tends to explore the environment. Spinal injuries have a poor prognosis. The lack of deep pain is indicative of complete spinal injury. Limb paralysis or paresis may also be the consequence of cerebral lesions. Head deviations (vestibular syndrome) are frequent (Fig. 97); middle or inner ear infections are the most likely cause, but they can also result from cerebral lesions.

The inspection of the oral cavity is quite an unpleasant procedure for the animal and should be left for last. The rabbit is to be held on the examination table by an assistant, if possible wrapped in a towel for better restraint, with its head on the edge of the table. An otoscope with a long cone is inserted into the labial commissure and the molar teeth of both dental arches are examined; the procedure is then repeated on the other side. The veterinary surgeon must be familiar with the normal conformation of molar teeth in order to not confuse their physiological serrated profile with pathological cusps (Figs. 98-99). Moreover, the bite is anisognathous, with the mandibular teeth closer to the midline than the maxillary teeth. The upper molar teeth emerge only partially (clinical crown); the emerged part of the lower molars is slightly greater.

Molar teeth may be characterized by irregularities in the occlusion plane (Fig. 100) (with teeth of different height and direction), dystrophy (with enamel abnormalities and loss of the physiological structure) and dental cusps of varying length (Figs. 101-102). Not infrequently only some teeth are affected by pathological alterations and these are located next to relatively normal teeth. The inspection of the oral cavity on a conscious rabbit allows the evaluation of no more than 50% of the teeth. If abnormalities are detected, for a more detailed examination general anaesthesia is necessary.

The normal body temperature is of 38.3°-40°C. Stress or a high ambient temperature can cause a significant rise in body temperature, even up to 40.5°C. Infections, however, rarely induce hyperthermia. In debilitated subjects a very low body temperature is easily found, of even 34°C or lower. The rectal mucosa is very delicate and easily prone to lesions; the temperature must therefore be measured with a thermometer made of soft plastic, small in diameter, of the type used for newborns and it should be well lubricated. During routine visits and in clinically healthy rabbits measuring rectal temperature is generally unnecessary.

EDUCATING THE OWNER

Given that almost all of the problems encountered in clinical practice result from mistakes in animal management, client education is particularly important for the prevention of diseases. In particular, the owner must be informed about the importance of a proper nutrition and the severe consequences of dietary mistakes, the importance of properly managing the rabbit at home to prevent accidents and the importance of handling it safely and properly (especially if small children are present). A regular immunization programme must be established and sterilization should be advised.

Diet
It is important to explain to the owner that the rabbit is an obligate herbivore and should be fed accordingly, so as to avoid the onset of serious disorders. The administration of inappropriate foods such as seeds and carbohydrates (cereals, bread, flaked products, etc.) can result in:

• insufficient wearing down of the teeth, abnormal teeth growth and the onset of chronic progressive malocclusion, abscesses and osteomyelitis of the jaws. Abscesses of the upper molar teeth can cause exophthalmos and blindness;
• slowing down of intestinal transit due to the absence of fibre which may evolve into complete intestinal stasis which can be fatal if left untreated;
• obesity, which may be the cause of serious diseases involving the heart, liver and kidneys. It may also be a predisposing factor for joint problems and pododermatitis.  Obesity greatly increases anaesthesia risks and reduces life expectancy.

Household management
Owners should be made aware that rabbits are not suited for living in a cage. Besides being a form of animal abuse, continuous confinement can bring about several diseases, including obesity, skeletal abnormalities, urinary retention and hence hypercalciuria, which can be the cause of perineal dermatitis.

The house must be made ​​safe (bunny-proofing) in order to avoid accidents. If the rabbit is taken outdoors this must happen in absolutely secure conditions and always under constant supervision.

Vaccinations
Rabbits should be vaccinated against two diseases, myxomatosis and rabbit haemorrhagic disease (RHD); these are viral diseases specific to the rabbit and both are deadly. The incidence varies according to the geographic location.

Several types of vaccines are available, mono- and bivalent, with duration of immunity ranging from 4-6 months to a year. Vaccine boosters must be continued throughout the rabbit’s life.

Sterilization
All pet rabbits should be spayed/neutered at the onset of sexual maturity. Sterilization has considerable benefits for the animal health and behaviour.

Sterilized rabbits are less aggressive and are cleaner (they have a decreased tendency to mark their territory with urine and faeces). Non-sterilized males have at times the tendency to continuously mount the hands and feet of the owners, other animals and various objects.

Spaying females prevents uterine adenocarcinoma (which appears starting from 3 years of age and has a very high incidence after 5), mammary tumours, uterine infections and pseudopregnancy.

If several rabbits live together sterilization becomes essential to avoid fierce fights between rabbits of the same sex or pregnancy in the event of rabbits of the opposite sex.

Pregnancy does not have any beneficial effect on the health of the female rabbit and does not contribute to the prevention of uterine pathologies.

Control visits
In healthy rabbits and until 4-5 years of age 1-2 control visits per year are recommended (they may coincide with the routine booster vaccinations). In older rabbits, 2-4 control visits per year are advisable, depending on the overall health status. Over 5-6 years of age blood chemistry tests, dental or thoracic and abdominal X-rays or ultrasound examinations may be prescribed, if necessary.