From GI stasis to liver torsions: Q&A on pursuing a diagnosis—and knowing when to wait—in exotic animal emergencies

A quiet, anorexic rabbit may appear stable at first glance, but according to Lauren Thielen, DVM, DABVP (Avian Practice), those subtle presentations can conceal serious underlying disease.

In this Q&A, Thielen discusses why the term “GI stasis” can be misleading in exotic animal medicine, how clinicians can avoid missing conditions such as liver lobe torsion in rabbits, and why early diagnostics, nutritional support, and species-specific stabilization strategies are critical for prey animals, which often mask illness until they are critically ill.

She also shares practical guidance for avian emergencies, emphasizing the importance of observational exams, minimizing handling stress, and stabilizing birds before pursuing aggressive diagnostics.

Editor’s note: This dvm360 Q&A has been edited and consolidated from a verbal interview to better fit a written format while retaining the substance of the original conversation.

dvm360: What are some of the most common exotic animal emergency presentations you see in practice?

Thielen: One of the most common exotic emergencies practitioners see is the noneating rabbit. Early in my career, we used this term "GI stasis": “The rabbit isn't eating, the rabbit isn't pooping, and this GI stasis syndrome just happens to rabbits.” But the more I've worked with rabbits, and the more the research has evolved, the clearer it is that that's a problematic name for what's actually happening.

Yes, the GI [gastrointestinal] tract is slowing down and losing normal peristalsis, but the main thing I want practitioners to take away is that GI stasis is inappropriately named because labeling something a syndrome implies there's no underlying cause. And there almost always is. Maybe there's dental disease. Maybe there's a metabolic problem—something wrong with the liver or kidneys.

One of the most significant developments in exotic medicine over the past decade—really even the past 5 years—is the recognition of liver lobe torsions in rabbits. One of the liver lobes, often the caudate, twists on itself, which causes pain and sometimes hemorrhage, and typically requires surgery or very aggressive medical management.

What's strange is that these rabbits often don't look as sick as you'd expect. You'd think an animal with that kind of organ damage would be obviously critical, but they can present as quiet and not eating. The owner brings them in, but the animal seems only mildly off. In the past, a lot of practitioners would give some subcutaneous fluids, syringe-feed some critical care formula, and send the rabbit home. But if you're not running blood work, if you're not imaging, if you're not doing the diagnostic workup because you think it's a syndrome, you're missing what's really going on. That's the core message I'm trying to drive home.

GI stasis is a bit of a soapbox for me, but it applies across exotic species. Cloacal prolapses in reptiles, metabolic syndromes in sugar gliders—so many of these presentations have an underlying cause.

These animals come in on an emergency basis, yes, but understanding what's driving the emergency is what allows you to actually address it.

dvm360: What are some of the key stabilization techniques and treatments for these emergencies?

Thielen: It really depends on the disease you're dealing with, which is exactly why I emphasize getting a diagnosis as early as possible. Unlike dogs and cats who can tolerate going without food for a while and who often present earlier in the disease course, exotic animals are prey species. They hide illness until they truly cannot anymore, and by the time they present, they are often critically ill. Getting that diagnosis early is paramount to a successful outcome.

The practical side of that means: How do you stabilize the patient? What parameters tell you how to hospitalize them appropriately? How do you obtain blood from an exotic species? How do you give fluids—intravenously or subcutaneously? And how do you feed them?

A dog can go a couple of days without eating, but a 60-gram bird cannot. So you need to provide nutritional support while you're working toward a diagnosis and getting them stable enough to handle more thorough workup. It's really about optimizing the environment and providing supportive care so you have the best chance of figuring out what's going on.

dvm360: What is your overall advice for veterinarians handling avian emergency presentations specifically?

Thielen: Always start with an observational exam. The reason I tell my students this is that sometimes a bird is so sick that picking it up to examine it could kill it in that moment.

My biggest piece of advice is: Do your observational exam first.

Understand how sick this bird is. If you need to give it 20 or 30 minutes, I promise you, not physically examining that bird for 30 minutes is not the reason it died.

Sometimes you just need to let the stress come down. Give them oxygen. Get them warm, into a warming incubator. Get them as stable as possible. Then when you do pick them up, do your exam in 5 seconds. Get the highlights and put them right back down.

That approach helps you understand what level of illness you're dealing with so you can move at the pace the bird needs. I talked a lot about how important early diagnosis is, but there's a saying in veterinary medicine: You don't want to diagnose your patient to death.

With a truly critical patient, you have to recognize that blood work and imaging may have to wait—maybe 2 hours, maybe a day or 2. Knowing how to hospitalize that bird appropriately and support them in the meantime is really one of the central goals of this kind of work.