Exotics Emergencies

Emergencies

Few sick reptiles present with acute illness

Chronic debilitation and decompensation are common

Manage supportively initially

This gives time to assess and investigate cause

Some true acute emergencies exist:

Prolapses

Shell trauma

Fractures

Cloacal prolapses

Prolapses are common and can be composed of:

Colon

Oviduct

Cloacal wall

Bladder (present in chelonia, some lizards)

One or both hemipenes (lizards and snakes)

Penis (chelonia)

The prolapsed organ may not be the site of the lesion

Any cause of straining or increased intracoelomic pressure can lead to

prolapse

Failure of resolution of the primary cause will invariably lead to recurrence

Common causes include: Bacterial or parasitic enteritis

Constipation/impaction

Dystocia

Infections/Inflammation of the reproductive tract

Mating trauma

Obesity

Urolithiasis

Coelomic masses

Hypocalcaemia

Minimum first aid

Protect prolapsed tissue

Clean off any contaminants

Cover with lubricant

Consider glucose application

Cover with dressing

Analgesia

Covering antibiotics if any evidence of devitalisation of tissue

Hemipene/Penile prolapse

In snakes and lizards hemipene lesions are invariably responsible Hemipenes are located in the tail, caudal to the

vent and are rarely affected by coelomic pathology

Localised infections are common causes of hemipene prolapse in leopard geckos

Coelomic or localised pathology can be responsible in chelonia The penis is located in the cloaca and

so is more likely to be affected by coelomic pathology

Hemipene infection and necrosis in a Crested gecko (Rhacodactylus ciliatus)

Traumatised hemipenes can be replaced, with a suture over the hemipene aperture if needed

Infected/necrotic hemipenes or chelonian penises can be amputated

A transfixing ligature is placed at the base

Sharp dissection allows removal

Fertility will be affected but amputation has no effects on the urinary tract

Photo courtesy of Kate Everett

Oviductal prolapse

Oviduct tissue is easily identified

Tubular organ

Roughened surface with many folds

Oviductal prolapse in a bearded dragon, secondary to unilateral oophoritis and salpingitis

To prolapse an oviduct, the supporting ligaments must be significantly damaged Replacement is unlikely to prevent recurrence

Blind replacement will also result in intussusception

Salpingectomy is recommended Unilateral salpingectomy and ovariectomy is

necessary

Retention of the ipsilateral ovary with stimulation from the contralateral oviduct can lead to ovulation of yolks into the coelom

Excised ovaries and oviducts, note disparity between inflamed tissue on left side and normal tissue on the right.

Urinary bladder prolapse

Rarely seen other than in chelonia

Urinary calculi are commonly responsible but coelomic causes can also cause prolapse

Chelonian bladders are bilobed

Pressure from the right lobe of the liver means most stones are in the left bladder lobe

Cystotomy can be carried out via a plastronotomy or a prefemoral approach

Prefemoral approach technically more demanding

Urine is not sterile in reptiles and leakage risks septic coelomitis

Closure of cystotomy incisions requires inversion of the bladder lining

Colonic prolapse

Small colonic prolapses can be treated with osmotic agents (e.g. glucose) to reduce oedema

Repeat or large prolapses (>1cm) require surgical pexy as supporting structures are likely damaged

A caudal coeliotomy is carried out and the colon sutured to the body wall

Incisional colonopexy provides greater stability long-term but carries a higher risk of dehiscence and coelomitis

Blind pexy is possible in snakes

Shell trauma

Common in outdoor tortoises

Lawnmowers

Children

Most commonly Jack Russells!

All wounds should be considered contaminated

Maintain as open wounds initially

Standard approach

Analgesia

Antibiotic therapy

Ceftazidine at 20mg/kg q3d

Secure loose fragments

Sterile dressing changes daily

Consider patching large defects once confident the area is not infected

Fibreglass or non-heating resin

Fractures

Primary fractures are rare Analgesia

External/Internal fixation methods

Pathological fractures are common Bones are palpably soft and radiographically

deformed

Manage pain and provide external support

Correct husbandry

Supplement calcium and vitamin D

Seizures

Uncommon

Main cause is chronic hypocalcaemia Can acutely decompensate

Often clear husbandry deficiencies

Hypoglycaemia Rarely in adults

Adenovirus (bearded dragons)

Paramyxovirus (snakes)

Thermal/physical trauma

Toxin exposure (insecticide treatment, herbivores)

First aid

Stop seizures

Diazepam

Propofol

Injectable/oral calcium

Supportive care

Ongoing Ca supplementation

Fluid and nutritional support

Further diagnostics

Birds

Parrots

Raptors

Small songbirds

Poultry

Wildlife

Fractures

Wing fractures typically result from in-flight injury

Leg fractures can occur when tethered or taking quarry

First Aid

Immobilise fracture

Figure of eight bandage for wing

Splint for leg

Analgesia

Antibiotic cover for open fractures

Prevent interference with bandage

Blunt beak or place beak tip prosthesis

Place collar

Supportive care for shock

Fluid therapy

Assist feeding/glucose administration

Wing fractures

Perfect healing is the only way to restore flight and hunting ability

Humeral fractures frequently open

Lack of soft tissue cover means that bone ends break through skin

when wings flap

Immediate stabilisation essential

Long-term bandaging is less than ideal

Immobilised joints lose range of movement

Results in permanent loss of aerial agility

Rigid surgical fixation typically required

Type of fixation depends on fracture type, location and infection status

Leg fractures

Tibiotarsus most frequently involved

Weak area present at level of fibular crest

Majority of leg fractures occur here

Tarsometatarsus and femur affected less

frequently

Toe fractures

Bones too small to pin

Splints/Ball bandages used

Must be changed at least every 5 days

Physiotherapy carried out at bandage changes to prevent

tendon contracture and joint

ankylosis

Squirrel bites

Some species, especially Harris Hawks, will take squirrels

Squirrel incisors are long and inflict deep foot punctures

Skin heals fastest and traps bacteria deep in the foot

Joint sepsis or bumblefoot can result and lead to permanent disabilities

Flush all injuries with saline and apply topical antiseptics to the skin

Assess toe mobility for tendon involvement

A course of antibiotics is essential to prevent infection developing

Marbofloxacin 20mg/kg sid

Amoxycillin-clavulanate 125mg/kg bid

Tick bites

Ixodes frontalis is a bird-specific tick

Adult ticks are carried by wild birds Branches above aviaries act as wild bird

perches

Adult ticks or eggs fall into aviaries

Birds will preen off ticks in most cases

Ticks attached around the face cannot be dislodged easily

Localised irritation can occur

Up to 50% of bitten birds may develop fatal bacterial infections after a tick bite

The causative bacterium has not been isolated but responds to Oxytetracyclines

Treat all birds with visible tick attachment, and any with areas of unexplained facial bruising

Treat aviaries with parasiticides Indorex prevents tick maturation without adverse

effects on birds

Wing Tip Oedema

Typically affects birds from warmer climates

E.g. Lanner falcons, Harris hawks

First year birds are most vulnerable

Can affect any bird exposed to extreme cold, especially in wet environments

Damage to the metacarpal region results from damage to the blood supply to the wing tip

Affected birds may be identified in the early stages when wing tips start to swell Wings are dropped The wing tip skin is swollen

and cold

Flight performance is affected

Some cases are not identified until late in the course of disease when the wing tips slough

Initial first aid

Warm the bird to 20C

Avoid direct heat on the skin

Stimulate blood flow

Have the bird on the fist and move the hand to encourage balancing wing movements

Gentle physiotherapy

Mild cases capable of flight can be flown for short periods

Ongoing care

Prompt medical therapy can lead to recovery in 90% cases

Improve blood flow before tissue dies Vasodilators given orally

Isoxsuprine (Navilox) 5-10mg/kg sid

Propentofylline (Vivitonin) 5mg/kg bid

Preparation H applied to affected skin

Antibiotics to prevent secondary infection

Sterile techniques to drain blisters

If wing tips drop off then flight will be affected permanently as the bone and

muscle is lost, not just feathers

Lead toxicity

Lead shot causes rapid toxicity

Sources are shot prey

Quarry caught that survived prior shot injury

Shot-killed prey fed in captivity

Weakness, disorientation and seizures can result

Contralateral ankle grasping is often seen

Diagnosis

Known exposure

Xrays Visible metal pieces

Lead pellets may already have been cast so are not always present

Dilated intestines

Enlarged kidneys

Measuring blood levels Can take several days

Treatment

Proventricular flushing under anaesthesia

Chelation Sodium calcium edetate (EDTA) binds metal

particles already absorbed

Continued for a minimum of 5 days

Purgatives Charcoal, liquid paraffin, peanut butter

Fluid therapy Essential to prevent lasting kidney damage

Sour crop

The crop fails to turn over and food putrefies

Bacterial toxins are absorbed

Toxaemia and septicaemia can be rapidly fatal

Full crop hours after feeding and foul smell from mouth are characteristic

True emergency

First aid

Crop emptying is possible in birds that remain strong

Manipulate contents out of mouth

High risk in weak birds as material is likely to be inhaled

Ingluviotomy required in advanced cases

Treatment

Broad spectrum antibiotics

Fluid therapy

Assist feeding

Severe cases require ingluviotomy tube placement and management of surgical site

as an open wound

Dyspnoea

Upper respiratory Fungal

Syringeal aspergilloma

Inhaled foreign body Millet seeds in cockatiels

Lower respiratory Usually chronic cause

Infectious: Chlamydia, aspergillosis Non-infectious: Cardiac disease, increased coelomic

pressure

Acute Teflon or chemical irritant exposure Hypersensitivity

Syringeal aspergilloma

Fungal granulomas form on the syringeal mucosal folds

Progressive air flow obstruction develops

Early signs include changes in vocalisation

Acute dyspnoea occurs as granulomas grow

Diagnosis: tracheoscopy

Treatment: Stabilisation: air sac tube, supportive care

Debridement (surgical/endoscopic)

Systemic antifungal therapy Itraconazole (toxic in AGPs), Voriconazole, Amphotericin B

Nebulisation

Dietary and environmental improvement

Inhaled foreign body

Transilluminate to identify

Air sac tube placement assists breathing

Cross-pin below obstruction with hypodermic needles under anaesthesia

Aspirate foreign body using suction

Hypersensitivity/inhaled irritants

Smoke, Teflon, aerosols, feather dander Remove primary cause Administer oxygen Consider adjunctive therapy based on expected

tissue damage Diuretics Covering antibiotic and antifungal therapy Anti-inflammatories Inhalational therapy e.g. Beta agonists AVOID STEROIDS

Generally good prognosis except Teflon

Mammals

Rabbits

Ferrets

Rodents

Rabbit small intestinal obstruction

Rapid progression compared to stasis

Bloated abdomen

Often present in shocked, depressed state

Hypothermic

Bradycardic

Palpably firm stomach

Radiographs show gas accumulation

Ultrasound may identify site of obstruction

Blood glucose typically >17mmol/l

Surgery indicated

Aggressive fluid therapy needed for shock

Pathophysiology of shock

Baroreceptors detect inadequate arterial stretch

Sympathetic AND vagal fibres stimulated

Heart rate DOES NOT increase

Bradycardia may occur exacerbating shock

Heart rate

Hypothermia and bradycardia potentiate each other

Hypothermia decreases adrenergic receptor sensitivity

Heart rate slows further

Peripheral vasoconstriction is impaired

A progressive deterioration results

Mucus membranes pale

Capillary refill slow/not evident

Fluid therapy in shock

Resuscitation with crystalloids alone leads to pleural and pulmonary fluid accumulation

A combined cystalloid/colloid therapy indicated 10-15ml/kg crystalloids as rapid infusion 5ml/kg colloids over 5-10mins Then ongoing infusion at 0.2-0.5ml/kg/hr

Once blood pressure >50mmHg then crystalloids alone are continued

Aggressive warming essential throughout

First aid

Establish IV/IO access, start on shock rates of fluids

Attempt to raise temperature

Surgery best treatment option

High risk anaesthesia patients

Always intubate and position with raised thorax

Consider stomach decompression prior to surgery

Midline laparotomy

Surgical approach Midline laparotomy

Incise from xiphoid to umbilicus

Identify affected region Usually just distal to pylorus

Congested mucosa overlying obstruction

Manipulate distally to caecum Time-consuming but better outcome than enterotomy

Supportive care and multimodal analgesia essential

Enterotoxaemia

Dysbiosis of intestinal tract of herbivores

Commonly due to clostridial overgrowth

Diet change

Primary GI disease

Antibiotic usage

Acutely weak, diarrhoeic animals

First aid

Fluid therapy IV/IO fluids with dextrose/glucose

Check faecal smear for clostridia Oral and systemic metronidazole if high index of

suspicion

Cholestyramine

In juveniles also consider acute coccidiosis

Supportive feeding, warmth

Guarded prognosis

Insulinoma

Ferret disease

Persistent hypoglycaemia (

First aid

Oral glucose therapy often sufficient

Fluid therapy

Ad lib food high protein, low carbohydrate food access

Longer term care

Measure insulin

Ultrasound scan of limited use

Partial pancreatectomy

Diazoxide (5-15mg/kg bid)

Prednisolone

Survival of 12-24months typical