1. Reptiles Health Care

2. Clinical Importance
More than 3.9 million US households with 1+ reptile pets
Ca and P derangements are common in pet reptiles
Preventable with proper husbandry and nutrition
Treatable with early intervention

3. Weight the reptile first

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

5. Turtles-hypovitaminosis
Hypovitaminosis A, red-eared slider turtle. Note the characteristic ocular swelling
This box turtle is exhibiting classic hypovitaminosis A, manifested by palpebral swelling, redness, pain, and accumulation of thick secretions. In some turtles, the eyes become glued shut

6. Vitamin A deficiency
Aural abscesses represent middle ear infections in turtles. In box turtles, these abscesses are commonly associated with vitamin A deficiencies.
Rx.- Vit. A 2000 IU/kg PO, SC, IM q7-14d x 2-4 Treatments
Enroflaxcin
Diet Correction

7. Hypocalcemia (<8.0 mg/dL)
Dietary deficiency
Excessive dietary phosphorus
Secondary nutritional hyperparathyroidism
Vitamin D3 deficiency (dietary or lack of UV light)
Hypobluminemia
Hypoparathyroidism

8. Hypocalcemia cont..
The fold of skin on the side of this iguana is evidence of dehydration
Lumpy jaw occurs when the body brings fibrous tissue to the area to stabilize the weak bones.

9. This is the femur (thigh) bone of a healthy iguana
This is the femur (thigh) bone of a healthy iguana. Compare it to the diseased one below
This is the thinning (arrow) that occurs in this disease

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

11. Hypercalcemia (>20mg/dL)
Excessive dietary calcium and vitamin D3
Primary hyperparathyroidism
Pseudohyperparathyroidism
Osteolytic bone disease

12. Phosphorus Clinical Pathology
Normal serum phosphorus: 1-5mg/dL

13. Hypophosphatemia
Starvation
Nutritional deficiency

14. Hyperphosphatemia (>5mg/dL)
Excessive dietary phosphorus
Hypervitamintosis D3
Renal disease
Severe tissue trauma
Osteolytic bone disease
Sample handling error

15. Nutritional Secondary Hyperparathyroidism (Metabolic Bone Disease)
Cause: diet low in calcium or vitamin D3, diet high in phosphorus, lack of exposure to UV-B light
Pathogenesis: Low serum Ca PTH secretion increased bone resorption

16. Nutrition and Nutritional Disease
Nutritional secondary hyperparathyroidism, iguana. The mandible often becomes decalcified in this condition, and bowing or shortening then occurs.
The mandible and maxilla of this green iguana are soft, spongy, and swollen due to nutritional secondary hyperparathyroidism

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

18. Septicemic Diseases “Shell rot”
Septicemic cutaneous ulcerative disease, slider turtle. Lesions are most obvious on the plastron (ventral surface).

19. Dermatitis
Ulcerative dermatitis (scale rot, necrotic dermatitis),. Contrary to popular belief, this is a disease that moves from the inside out, rather than outside in. The inciting cause is compromised immunity with subsequent invasion of bacteria
Secondary infection with Aeromonas spp , Pseudomonas spp , and a number of other bacteria may result in septicemia and death if untreated

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

21. Dysecdesis
When snakes have difficulty shedding , cutaneous damage can occur. In extreme cases, secondary bacterial infections can result
Blue color for one week then shed process, soak in water using an aquariums for severe case or use soaked paper towels in the aquarium, make sure to use a big bowl of water for big snakes for drinking and use it for soaking

22. Difficulty shedding (dysecdesis)
Subspectacle abscessation is a common ocular problem in snakes. Retained eye caps and subsequent damage is often the initiating cause.
Subspectacle abscessation, African ball python. This snake was treated with enrofloxacin (5-10 mg/kg q24hr PO,SC,IM) and returned to normal after 2 subsequent shedding cycles

23. Ulcerative Stomatitis (mouth rot)
Early symptoms may be subtle and often overlooked: slight petechia; inappetence, a reluctance to feed or change in food selection; and increased, thickened, ropey or sheeting saliva.
In cases of sudden and severe onset, there may be acute inflammation of the buccal and pharyngeal membranes or gingival necrosis. Pockets of caseous yellow, yellowish-gray or white-gray pus may occur in the soft tissues.
Left untreated, the condition may progress to osteomyelitis of the mandibular and cranial structures

24. Stomatitis cont…
A variety of organisms have been associated with stomatitis, such as Aeromonas aerogenes, A. aerophila, A. hydrophila, Citrobacter freundii, Proteus sp., Pseudomonas aeruginosa P. fluorescens, Staphylococcus sp., and Streptococcus

25. Treatment
Dilute solutions of povidone-iodine (Betadine®) or chlorhexidine diacetate (Nolvasan®) are two products with low cytotoxicity.
Flush the mouth with the dilute solution of 1% povidone-iodine or a 0.25%-0.5% solution of chlorhexidine diacetate.[1] Debride using the curettes or tweezer. The resultant cavity must be checked to ensure removal of all the material. Any loose detritus should be swabbed away with a swab dipped in the dilute solution. Once the plaques are removed, the mouth should be flushed again
Systemic Antibiotics (Enroflaxcin)

26. Drug Dosage/Route/Frequency
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)
Carbenicillin 200 mg/kg IM q 48 hrs (tortoises)
Ceftazidime (Fortaz) 20 mg/kg IM q 72 hrs (snakes)
Enrofloxacin (Baytril)* 5 mg/kg PO, SQ, IM q hrs; 10 mg/kg PO, SQ, IM q 24 hrs for resistant infection
Gentamicin (Gentocin) 2.5 mg/kg IM q 72 hrs (snakes)   6 mg/kg IM q hrs (red-eared slider)
Piperacillin* 100 mg/kg IM q 48 hrs (pythons)

27. Prolapse of Cloacal Tissue and Hemipenes

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

29. Prolapse
Turning out; inside out. Eversion

30. hemipene
The male reproductive organ in snakes and lizards, kept inverted in the tail until needed. Chelonians have a single penis.

31. A prolapse is the eversion of tissue into an area where it should not be. In iguanas (and reptiles in general), three types of prolapse may be occur that can be seen by the owner.
Reptiles are like birds in that they have a single chamber into which feces and urates are deposited before being voided. Through this same chamber passes sperm, and eggs (or live babies, in viviparous species, hatchlings in ovoviviparous species) in the female. This chamber, the cloaca, is found just inside the vent

32. In the normal course of defecation, the male hemipenes may be everted, that is, will be forced out of the vent. They will revert back (be pulled back in by the muscles) into their normal position within a few moments.
During breeding season, males will frequently evert their hemipenes in conjunction with depositing some seminal material

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

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

36. Injuries caused by live prey
Don not feed sick animals with live prey

37. Rodent bites
Inflicted by uneaten prey, frequently cause traumatic injuries; secondary infection and abscessation are common sequelae.
Untreated wounds frequently abscess and are seen as a soft or hard swelling. The abscess, including the fibrous capsule, should be removed surgically, and the defect sutured

38. Bites….
Fresh bite wounds may be treated by cleansing and saturating with povidone-iodine (diluted 1:10). Parenteral antibiotics, based on results of culture and sensitivity tests, should be used
Antibiotic ointments with proteolytic enzymes may be helpfu

39. Questions?
Yummy