ReptilesReptiles

Health Care Health Care

Clinical ImportanceClinical Importance

More than 3.9 million US households More than 3.9 million US households with 1+ reptile petswith 1+ reptile pets

Ca and P derangements are common Ca and P derangements are common in pet reptilesin pet reptiles

Preventable with proper husbandry Preventable with proper husbandry and nutritionand nutrition

Treatable with early interventionTreatable with early intervention

Weight the reptile first Weight the reptile first

Vitamin A deficiency Vitamin A deficiency

Vitamin A is important Vitamin A is important in maintaining all in maintaining all epithelial cells, but the epithelial cells, but the respiratory tree appears respiratory tree appears to be particularly to be particularly sensitive. This turtles sensitive. This turtles clear, bubbly nose is clear, bubbly nose is reflective of a vitamin A reflective of a vitamin A deficiency. This can deficiency. This can easily lead to easily lead to pneumonia from pneumonia from opportunistic bacteria opportunistic bacteria

Turtles-hypovitaminosisTurtles-hypovitaminosis

Hypovitaminosis A, red-eared slider turtle. Note the Hypovitaminosis A, red-eared slider turtle. Note the characteristic ocular swelling characteristic ocular swelling

This box turtle is exhibiting classic hypovitaminosis A, This box turtle is exhibiting classic hypovitaminosis A, manifested by palpebral swelling, redness, pain, and manifested by palpebral swelling, redness, pain, and accumulation of thick secretions. In some turtles, the accumulation of thick secretions. In some turtles, the eyes become glued shut eyes become glued shut

Vitamin A deficiency Vitamin A deficiency Aural abscesses represent middle ear infections in turtles. In Aural abscesses represent middle ear infections in turtles. In

box turtles, these abscesses are commonly associated with box turtles, these abscesses are commonly associated with vitamin A deficiencies. vitamin A deficiencies.

Rx.- Vit. A 2000 IU/kg PO, SC, IM q7-14d x 2-4 TreatmentsRx.- Vit. A 2000 IU/kg PO, SC, IM q7-14d x 2-4 Treatments

EnroflaxcinEnroflaxcin Diet Correction Diet Correction

Hypocalcemia (<8.0 mg/dL)Hypocalcemia (<8.0 mg/dL)

Dietary deficiencyDietary deficiency Excessive dietary phosphorusExcessive dietary phosphorus Secondary nutritional Secondary nutritional

hyperparathyroidismhyperparathyroidism Vitamin D3 deficiency (dietary or lack of Vitamin D3 deficiency (dietary or lack of

UV light)UV light) HypobluminemiaHypobluminemia HypoparathyroidismHypoparathyroidism

Hypocalcemia cont..Hypocalcemia cont..

Lumpy jaw occurs when the body brings Lumpy jaw occurs when the body brings fibrous tissue to the area to stabilize the fibrous tissue to the area to stabilize the weak bones.weak bones.

The fold of skin on the side of this The fold of skin on the side of this iguana is evidence of dehydrationiguana is evidence of dehydration

This is the femur (thigh) bone of a healthy This is the femur (thigh) bone of a healthy iguana. Compare it to the diseased one iguana. Compare it to the diseased one

belowbelow

This is the thinning (arrow) This is the thinning (arrow) that occurs in this diseasethat occurs in this disease

This disease also occurs in tortoises.This disease also occurs in tortoises.The shell is soft due to inadequate The shell is soft due to inadequate nutritionnutrition-Rx. Ca gluconate 10-50mg/kg IM-Rx. Ca gluconate 10-50mg/kg IM-Correct the diet -Correct the diet

Hypercalcemia (>20mg/dL)Hypercalcemia (>20mg/dL) Excessive dietary calcium and Excessive dietary calcium and

vitamin D3vitamin D3 Primary hyperparathyroidismPrimary hyperparathyroidism PseudohyperparathyroidismPseudohyperparathyroidism Osteolytic bone diseaseOsteolytic bone disease

Phosphorus Clinical Phosphorus Clinical PathologyPathology

Normal serum phosphorus: 1-5mg/dLNormal serum phosphorus: 1-5mg/dL

HypophosphatemiaHypophosphatemia

StarvationStarvation Nutritional deficiencyNutritional deficiency

Hyperphosphatemia Hyperphosphatemia (>5mg/dL)(>5mg/dL)

Excessive dietary phosphorusExcessive dietary phosphorus Hypervitamintosis D3Hypervitamintosis D3 Renal diseaseRenal disease Severe tissue traumaSevere tissue trauma Osteolytic bone diseaseOsteolytic bone disease Sample handling errorSample handling error

Nutritional Secondary Nutritional Secondary HyperparathyroidismHyperparathyroidism(Metabolic Bone Disease)(Metabolic Bone Disease)

Cause: diet low in calcium or vitamin D3, Cause: diet low in calcium or vitamin D3, diet high in phosphorus, lack of exposure to diet high in phosphorus, lack of exposure to UV-B lightUV-B light

Pathogenesis: Low serum CaPathogenesis: Low serum Ca PTH PTH secretionsecretion increased bone resorption increased bone resorption

Nutrition and Nutritional Nutrition and Nutritional Disease Disease

Nutritional secondary Nutritional secondary hyperparathyroidism, hyperparathyroidism, iguana. The mandible iguana. The mandible often becomes often becomes decalcified in this decalcified in this condition, and bowing or condition, and bowing or shortening then occurs. shortening then occurs.

The mandible and The mandible and maxilla of this green maxilla of this green iguana are soft, spongy, iguana are soft, spongy, and swollen due to and swollen due to nutritional secondary nutritional secondary hyperparathyroidism hyperparathyroidism

Abnormal beak growthAbnormal beak growth,,

it is often associated it is often associated with nutritional with nutritional secondary secondary hyperparathyroidism hyperparathyroidism leading to leading to hypocalcemia, which hypocalcemia, which may cause distortion may cause distortion of the skull as it of the skull as it develops and thus develops and thus interfere with normal interfere with normal occlusion and wear occlusion and wear

Septicemic Diseases Septicemic Diseases “Shell rot”“Shell rot”

Septicemic Septicemic cutaneous cutaneous ulcerative disease, ulcerative disease, slider turtle. slider turtle. Lesions are most Lesions are most obvious on the obvious on the plastron (ventral plastron (ventral surface). surface).

DermatitisDermatitis

Ulcerative dermatitis (scale rot, necrotic Ulcerative dermatitis (scale rot, necrotic dermatitis),. Contrary to popular belief, this is a dermatitis),. Contrary to popular belief, this is a disease that moves from the inside out, rather disease that moves from the inside out, rather than outside in. The inciting cause is compromised than outside in. The inciting cause is compromised immunity with subsequent invasion of bacteria immunity with subsequent invasion of bacteria

Secondary infection with Secondary infection with AeromonasAeromonas spp , spp , PseudomonasPseudomonas spp , and a number of other spp , and a number of other bacteria may result in septicemia and death if bacteria may result in septicemia and death if untreateduntreated

DysecdysisDysecdysis

Refers to an incomplete Refers to an incomplete or inadequate shed. or inadequate shed. Low humidity and other Low humidity and other stresses, including stresses, including decreased thyroid decreased thyroid function, function, ectoparasitism, ectoparasitism, nutritional deficiencies, nutritional deficiencies, infectious diseases, and infectious diseases, and lack of suitable lack of suitable abrasive surfaces, have abrasive surfaces, have been incriminated as been incriminated as contributing factors contributing factors

DysecdesisDysecdesis

When snakes have When snakes have difficulty shedding , difficulty shedding , cutaneous damage can cutaneous damage can occur. In extreme cases, occur. In extreme cases, secondary bacterial secondary bacterial infections can result infections can result

Blue color for one week Blue color for one week then shed process, soak in then shed process, soak in water using an aquariums water using an aquariums for severe case or use for severe case or use soaked paper towels in the soaked paper towels in the aquarium, make sure to aquarium, make sure to use a big bowl of water for use a big bowl of water for big snakes for drinking and big snakes for drinking and use it for soakinguse it for soaking

Difficulty shedding Difficulty shedding (dysecdesis)(dysecdesis)

Subspectacle Subspectacle abscessation is a common abscessation is a common ocular problem in snakes. ocular problem in snakes. Retained eye caps and Retained eye caps and subsequent damage is subsequent damage is often the initiating cause. often the initiating cause.

Subspectacle Subspectacle abscessation, African ball abscessation, African ball python. This snake was python. This snake was treated with enrofloxacin treated with enrofloxacin (5-10 mg/kg q24hr (5-10 mg/kg q24hr PO,SC,IM) and returned to PO,SC,IM) and returned to normal after 2 normal after 2 subsequent shedding subsequent shedding cycles cycles

Ulcerative Stomatitis (mouth Ulcerative Stomatitis (mouth rot)rot) Early symptoms may be Early symptoms may be

subtle and often overlooked: subtle and often overlooked: slight petechia; inappetence, slight petechia; inappetence, a reluctance to feed or a reluctance to feed or change in food selection; and change in food selection; and increased, thickened, ropey increased, thickened, ropey or sheeting saliva. or sheeting saliva.

In cases of sudden and In cases of sudden and severe onset, there may be severe onset, there may be acute inflammation of the acute inflammation of the buccal and pharyngeal buccal and pharyngeal membranes or gingival membranes or gingival necrosis. Pockets of caseous necrosis. Pockets of caseous yellow, yellowish-gray or yellow, yellowish-gray or white-gray pus may occur in white-gray pus may occur in the soft tissues. the soft tissues.

Left untreated, the condition Left untreated, the condition may progress to may progress to osteomyelitis of the osteomyelitis of the mandibular and cranial mandibular and cranial structures structures

Stomatitis cont…Stomatitis cont…

A variety of organisms A variety of organisms have been associated have been associated with stomatitis, such as with stomatitis, such as Aeromonas aerogenesAeromonas aerogenes, , A. aerophilaA. aerophila, , A. A. hydrophilahydrophila, , Citrobacter Citrobacter freundiifreundii, , ProteusProteus sp., sp., Pseudomonas Pseudomonas aeruginosaaeruginosa P. P. fluorescensfluorescens,, Staphylococcus Staphylococcus sp., and sp., and StreptococcusStreptococcus

TreatmentTreatment

Dilute solutions of povidone-iodine (Betadine®) or Dilute solutions of povidone-iodine (Betadine®) or chlorhexidine diacetate (Nolvasan®) are two products with chlorhexidine diacetate (Nolvasan®) are two products with low cytotoxicity. low cytotoxicity.

Flush the mouth with the dilute solution of 1% povidone-Flush the mouth with the dilute solution of 1% povidone-iodine or a 0.25%-0.5% solution of chlorhexidine diacetate.iodine or a 0.25%-0.5% solution of chlorhexidine diacetate.[1] Debride using the curettes or tweezer. The resultant [1] Debride using the curettes or tweezer. The resultant cavity must be checked to ensure removal of all the cavity must be checked to ensure removal of all the material. Any loose detritus should be swabbed away with a material. Any loose detritus should be swabbed away with a swab dipped in the dilute solution. Once the plaques are swab dipped in the dilute solution. Once the plaques are removed, the mouth should be flushed again removed, the mouth should be flushed again

Systemic Antibiotics (Enroflaxcin)Systemic Antibiotics (Enroflaxcin)

Drug Drug Dosage/Route/FrequencyDosage/Route/Frequency

Amikacin (Amiglyde) 5 mg/kg SQ, IM then 2.5 mg/kg Amikacin (Amiglyde) 5 mg/kg SQ, IM then 2.5 mg/kg q 72 hrs (snakes);2.25 mg/kg IM q 96 hrs (alligators) q 72 hrs (snakes);2.25 mg/kg IM q 96 hrs (alligators)

Carbenicillin 200 mg/kg IM q 48 hrs (tortoises) Carbenicillin 200 mg/kg IM q 48 hrs (tortoises) Ceftazidime (Fortaz) 20 mg/kg IM q 72 hrs (snakes) Ceftazidime (Fortaz) 20 mg/kg IM q 72 hrs (snakes) Enrofloxacin (Baytril)* 5 mg/kg PO, SQ, IM q 24-38 Enrofloxacin (Baytril)* 5 mg/kg PO, SQ, IM q 24-38

hrs; 10 mg/kg PO, SQ, IM q 24 hrs for resistant hrs; 10 mg/kg PO, SQ, IM q 24 hrs for resistant infection infection

Gentamicin (Gentocin) 2.5 mg/kg IM q 72 hrs (snakes) Gentamicin (Gentocin) 2.5 mg/kg IM q 72 hrs (snakes)   6 mg/kg IM q 72-96 hrs (red-eared slider)   6 mg/kg IM q 72-96 hrs (red-eared slider)

Piperacillin* 100 mg/kg IM q 48 hrs (pythons) Piperacillin* 100 mg/kg IM q 48 hrs (pythons)

Prolapse of Cloacal Tissue Prolapse of Cloacal Tissue and Hemipenes and Hemipenes

Cloaca Cloaca

A passage used for eliminating fecal, A passage used for eliminating fecal, urinary and reproductive discharges. urinary and reproductive discharges. From the Latin word meaning From the Latin word meaning "sewer". Reptiles, like birds, have a "sewer". Reptiles, like birds, have a chamber into which the contents of chamber into which the contents of the bladder and anus flow prior to the bladder and anus flow prior to being eliminated from the body. This being eliminated from the body. This chamber lies inside the vent (venter). chamber lies inside the vent (venter).

ProlapseProlapse

Turning out; inside out. Eversion Turning out; inside out. Eversion

hemipene hemipene The male reproductive organ in The male reproductive organ in

snakes and lizards, kept inverted in snakes and lizards, kept inverted in the tail until needed. Chelonians the tail until needed. Chelonians have a single penis. have a single penis.

A prolapse is the eversion of tissue into an area A prolapse is the eversion of tissue into an area where it should not be. In iguanas (and reptiles where it should not be. In iguanas (and reptiles in general), three types of prolapse may be in general), three types of prolapse may be occur that can be seen by the owner.occur that can be seen by the owner.

Reptiles are like birds in that they have a single Reptiles are like birds in that they have a single chamber into which feces and urates are chamber into which feces and urates are deposited before being voided. Through this deposited before being voided. Through this same chamber passes sperm, and eggs (or live same chamber passes sperm, and eggs (or live babies, in viviparous species, hatchlings in babies, in viviparous species, hatchlings in ovoviviparous species) in the female. This ovoviviparous species) in the female. This chamber, the cloaca, is found just inside the chamber, the cloaca, is found just inside the vent vent

In the normal course of defecation, the male In the normal course of defecation, the male hemipenes may be everted, that is, will be forced hemipenes may be everted, that is, will be forced out of the vent. They will revert back (be pulled out of the vent. They will revert back (be pulled back in by the muscles) into their normal position back in by the muscles) into their normal position within a few moments. within a few moments.

During breeding season, males will frequently During breeding season, males will frequently evert their hemipenes in conjunction with evert their hemipenes in conjunction with depositing some seminal materialdepositing some seminal material

If the iguana is constipated, If the iguana is constipated, either due to dehydration, either due to dehydration, impaction due to a foreign impaction due to a foreign object, or from being heavily object, or from being heavily parasitized, the strain of parasitized, the strain of trying to defecate may result trying to defecate may result in either a section of the in either a section of the colon or cloacal tissue, or one colon or cloacal tissue, or one or both hemipenes, being or both hemipenes, being everted through the vent. everted through the vent. Severe parasite infestation Severe parasite infestation and dystocia may also result and dystocia may also result in prolapsed tissue. in prolapsed tissue.

Treatment Treatment

You can try soaking the iguana in a cool You can try soaking the iguana in a cool bath to which sugar has been added. bath to which sugar has been added. Heavy concentrations of sugar in the Heavy concentrations of sugar in the water will act to draw out the fluids water will act to draw out the fluids engorging the swollen everted tissue; engorging the swollen everted tissue; this may reduce it enough to be inverted this may reduce it enough to be inverted by the lizard. The tissue may be rinsed by the lizard. The tissue may be rinsed with fresh water and Betadine, and with fresh water and Betadine, and carefully pushed back in with a gloved carefully pushed back in with a gloved finger lubricated with KY Jelly finger lubricated with KY Jelly

Injuries caused by live preyInjuries caused by live prey

Don not feed sick Don not feed sick animals with live animals with live prey prey

Rodent bitesRodent bites

Inflicted by uneaten Inflicted by uneaten prey, frequently cause prey, frequently cause traumatic injuries; traumatic injuries; secondary infection secondary infection and abscessation are and abscessation are common sequelae.common sequelae.

Untreated wounds Untreated wounds frequently abscess and frequently abscess and are seen as a soft or are seen as a soft or hard swelling. The hard swelling. The abscess, including the abscess, including the fibrous capsule, should fibrous capsule, should be removed surgically, be removed surgically, and the defect sutured and the defect sutured

Bites….Bites….

Fresh bite wounds may Fresh bite wounds may be treated by cleansing be treated by cleansing and saturating with and saturating with povidone-iodine povidone-iodine (diluted 1:10). (diluted 1:10). Parenteral antibiotics, Parenteral antibiotics, based on results of based on results of culture and sensitivity culture and sensitivity tests, should be usedtests, should be used

Antibiotic ointments Antibiotic ointments with proteolytic with proteolytic enzymes may be helpfu enzymes may be helpfu

Questions?

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