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Gastrointestinal obstruction

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Introduction

  • Cause: ingestion of foreign material such as substrate, or fecal obstipation (the latter is often related to husbandry and dietary issues such as overfeeding, dehydration, low environmental temperatures and hypocalcemia/metabolic bone disease). Less commonly due to luminal obstruction by a mass, eg neoplasm, or intussusception. Rarely a urolith may move into the distal gastrointestinal tract causing obstruction.
  • Signs: often non-specific, such as lethargy, anorexia and dehydration. Weight and body condition loss may be seen with chronic obstruction, and reptiles may present late in the course of obstruction as keepers may be unaware of any foreign body ingestion and may not pick up on early signs of disease. Regurgitation, vomiting or tenesmus may be seen, although not consistently. Snakes and lizards may show coelomic distension, and foreign bodies or impacted feces may sometimes be palpable.
  • Diagnosis: there may be a history of foreign body ingestion or lack of fecal output, although this is not always the case. Radiography can be useful to identify radiodense foreign bodies, whilst contrast studies, oral endoscopy, ultrasonography and computed tomography may help to elucidate less obvious obstructions. It is extremely important to differentiate between obstructive foreign bodies or masses and non-obstructed material within the gut that is likely to pass, eg worm mass, food. The latter are usually asymptomatic or mild in presentation and can be treated medically, whilst obstructive objects or masses will require surgery.
  • Treatment: generally surgical for true gastrointestinal obstruction: exploratory celiotomy to remove the foreign body or impacted feces. Enterotomy or enterectomy may need to be performed, depending on the viability of the affected gut. Occasionally oral or cloacal endoscopic removal of the obstructing object may be possible.
  • Prognosis: good to guarded dependent on the chronicity of the condition (ie speed of presentation), level of gastrointestinal damage and any concurrent disease processes.
Print off the Owner Factsheets on Digestive disorders in chameleons, Digestive disorders in geckos, Digestive disorders in lizards, Digestive disorders in snakes, Digestive disorders in terrapins and/or Digestive disorders in tortoises to give to your clients.

Presenting signs

  • May vary according to the chronicity of the condition.

Acute presentation

  • The owner may have witnessed foreign body ingestion.
  • Non-specific marked lethargy, anorexia Anorexia and dehydration.
  • Vomiting, regurgitation (particularly in snakes) and/or tenesmus may be seen.
  • Reduced or no recent fecal output.
  • Sometimes coelomic pain is apparent.
  • Often affected reptiles are presented relatively late in the development of disease and may show signs consistent with chronic disease such as weight loss and cachexia Cachexia.

Geographic incidence

  • Worldwide.

Age predisposition

  • All ages susceptible, although younger individuals may be more likely to deliberately eat unsuitable items.
  • Obstipation associated with hypocalcemia and metabolic bone disease is more likely to be seen in juvenile reptiles.
  • Obstruction of the lumen by an intra-luminal or extra-luminal mass may be more common in older individuals, eg due to neoplasia.

Breed/Species predisposition

  • Insectivorous lizards such as Leopard geckos Leopard gecko (Eublepharis macularius) and Bearded dragons Bearded dragons (Pogona) commonly ingest substrate material such as woodchip and calcium carbonate sands , whilst chelonians often ingest woody plant material and pebbles. Bearded dragons appear prone to selecting and ingesting inappropriate material.
  • Snakes rarely ingest foreign material, but occasionally do so when taking a prey item.

Public health considerations

  • None, other than the general potential zoonotic pathogens within reptilian gastrointestinal tracts such as Salmonella spp.

Cost considerations

  • Diagnosis may not be simple, necessitating imaging, with inherent cost, and the keeper must be prepared to take on any costs involved with surgery.
  • The keeper should also be prepared to give supportive care post-treatment and address any potential issues with husbandry or diet.
  • If the reptile is severely clinically affected and the keeper cannot or will not allow appropriate treatment, euthanasia Euthanasia must be considered on welfare grounds.

Special risks

  • Reptiles often present relatively late in the course of disease, and as such may have concurrent issues, such as dehydration, making procedures such as anesthesia more risky.
  • Fecal obstipation causing gastrointestinal obstruction may be associated with suboptimal husbandry (eg low environmental temperatures, hypocalcemia) and these individuals are likely to have concurrent disease. A full assessment and stabilization plan should be made prior to treatment.

Pathogenesis

Etiology

  • Ingestion of foreign material whether accidental, eg ingesting substrate whilst taking a prey item, or deliberate .
  • Fecal obstipation (in severe cases may cause gastrointestinal obstruction).
  • Space-occupying lesions or extraluminal gastrointestinal obstruction, eg due to neoplasia , abscessation, a mass of worms, etc.
  • Rarely, uroliths may move into the distal gastrointestinal tract causing obstruction.

Predisposing factors

General

  • Access to inappropriate objects to ingest.
  • Poor substrate choice for the species concerned.
  • Overfeeding, poor water provision, poor dietary provision of calcium and vitamin D, lack of or unsuitable species-specific ultraviolet light (UVB) provision and suboptimal environmental temperature provision may be associated with fecal obstipation. This is particularly common in Bearded dragons.
  • Pica may occur in some species, although the reason for the behavior is not clear. Some reptiles seek white material such as white pebbles or bone if calcium-deficient, or in times of high calcium demand.

Specific

  • Neoplasia.
  • Abscess.

Pathophysiology

  • Mechanical obstruction of the gastrointestinal tract leading to increased gastrointestinal wall tension and loss of blood supply with resultant ischemic necrosis and potential bowel perforation. Shock and death may ensue.

Timecourse

  • Variable: some reptiles will show clinical signs acutely, whilst others will present very late in the course of disease. The latter group are likely to have a poorer prognosis.

Epidemiology

  • Varies according to primary cause.
  • Usually individuals and not groups of animals are affected.

Diagnosis

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Treatment

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Prevention

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Mans C (2013) Clinical update on diagnosis and management of disorders of the digestive system of reptiles. J Exotic Pet Med 22 (2), 141-162 JExoticPetMed.
  • Wright K (2008) Two common disorders of captive Bearded dragons (Pogona vitticeps): Nutritional secondary hyperparathyroidism and constipation. J Exotic Pet Med 17 (4), 267-272 JExoticPetMed.
  • Mitchell M A (2005) Clinical reptile gastroenterology. Vet Clin North Am Exotic Anim Pract 8 (2), 277–298 PubMed.
  • Kik M J L & Nickel R F (2001) Removal of a foreign body from the intestine of a leopard tortoise (Geochelone pardalis) via laparoscopy. Praktische Tierarzt 82 (3), 174-179 VetMedResource.

Other sources of information

  • Brown S J L, Naylor A D, Machin R A & Pellett S (In press) Gastrointestinal System. In: BSAVA Manual of Reptiles. 3rd edn. Eds: Girling S J & Raiti P. BSAVA, UK.
  • Johnson R & Doneley B (2018) Diseases of the Gastrointestinal System. In: Reptile Medicine and Surgery in Clinical Practice. Eds: Doneley B, Monks D, Johnson R & Carmel B. Wiley-Blackwell, USA. pp 273-286.
  • Jepson L (2016) Snakes, Lizards, Tortoises and Turtles. In: Exotic Animal Medicine. A Quick Reference Guide. 2nd edn. Elsevier, USA. pp 343-474.
  • Chitty J & Raftery A (2013) Imaging. In: Essentials of Tortoise Medicine and Surgery. Wiley-Blackwell, UK. pp 121-122.
  • Chitty J & Raftery A (2013) Vomiting and Regurgitation. In: Essentials of Tortoise Medicine and Surgery. Wiley-Blackwell, UK. pp 93-96.
  • Diaz-Figueroa O & Mitchell M A (2006) Gastrointestinal Anatomy and Physiology. In: Reptile Medicine and Surgery. 2nd ed. Ed: Mader D R. Saunders, USA. pp 145-162.
  • McArthur S (2004) Problem-solving Approach to Common Diseases. In: Medicine and Surgery of Tortoises and Turtles. Eds: McArthur S, Wilkinson R & Meyer J. Blackwell, USA. pp 333-349.
  • McArthur S, McLellan L & Brown S (2004) Gastrointestinal System. In: BSAVA Manual of Reptiles. 2nd edn. Eds: Girling S J & Raiti P. BSAVA, UK. pp 210-229.