Avian & Reptile Reproductive Issues PDF

10/8/24 0/41 INTRODUCTION TO AVIAN & REPTILE REPRODUCTIVE ISSUES 0 INTRODUCTION PHYS EXAM CASE INVEST DIAGN IMAGING MEDICAL THERAPY SURGERY...

10/8/24 0/41 INTRODUCTION TO AVIAN & REPTILE REPRODUCTIVE ISSUES 0 INTRODUCTION PHYS EXAM CASE INVEST DIAGN IMAGING MEDICAL THERAPY SURGERY Aims & Objectives 1/41 Appreciate that reproductive issues are very common in birds and reptiles but only a few will be covered in class – Excessive egg production – Dystocia – Cloacal prolapse Be able to identify male and female of common species Be able to identify abnormal presentations and know how to undertake a diagnostic investigation Know the medical and surgical options for treatment Watch the ELC surgery videos. 1 1  10/8/24 INTRODUCTION PHYS EXAM CASE INVEST DIAGN IMAGING MEDICAL THERAPY SURGERY Don’t Forget To Review Anatomy & Physiology! 2/41 Please review your reptile and avian reproductive anatomy and physiology from first year – I have included a short lecture PDF called “DIVERS reptile bird repro anatomy and phys” in ELC Tempera ture Dep Most chelo endent nians Sex Dete é o C = fe rminatio Few li zards male, ê o C = male n (snakes? éo C = m ale, ê o C ) 19/21 = female. 2 INTRODUCTION PHYS EXAM CASE INVEST DIAGN IMAGING MEDICAL THERAPY SURGERY Many Reproductive Problems! 3/41 Female Male – Excessive egg production – Cloacal prolapse – Dystocia (egg binding) – Neoplasia – Cloacal prolapse – Behavioral anomalies – Behavioral anomalies – feather picking, self-mutilation feather picking, self-mutilation – Failure to reproduce – Ova/egg related coleomitis – Orchitis – Oophoritis, cystic ovary – Neoplasia – Ectopic eggs & non-septic coelomitis – Salpingitis, metritus – Oviductal impaction – Oviductal cystic hyperplasia – Failure to reproduce 3 2  10/8/24 4/41 REPTILES 4 INTRO PHYSICAL EXAMINATION CASE INVEST DIAGN IMAGING MEDICAL THERAPY SURGERY Clinical History 5/41 Often Spring-Summer (anytime?) Previous copulation (but male unnecessary!) Digging / Restless Eggs in vivarium Prolapse Enlarged girth Anorexia & lethargy. 5 3  10/8/24 INTRO PHYSICAL EXAMINATION CASE INVEST DIAGN IMAGING MEDICAL THERAPY SURGERY Physical Examination 6/41 Confirm sex & age (juvenile, adult, geriatric) – Differential diagnoses and clinical direction stems from this information! If you cannot differentiate male from female, juvenile from adult, then you should probably offer referral. 6 INTRO PHYSICAL EXAMINATION CASE INVEST DIAGN IMAGING MEDICAL THERAPY SURGERY Male Examination 7/41 Prolapse is most common, secondary to tenesmus, often traumatized – Phallus, hemipenes – Differentiate from cloaca, colon, bladder Hemipenal enlargement (abscess) Coelomic enlargement is uncommon – Testicular mass, abscess, neoplasm. 7 4  10/8/24 INTRO PHYSICAL EXAMINATION CASE INVEST DIAGN IMAGING MEDICAL THERAPY SURGERY Female Examination 8/41 Coelomic enlargement is common – Enlarged ovaries or retained egg(s) – Differentiate normal vs abnormal Prolapse is also common – Secondary to coelomic mass effect (tenesmus) – Oviduct, cloaca, colon, bladder. 8 INTRO PHYS EXAM CASE INVESTIGATION DIAGN IMAGING MEDICAL THERAPY SURGERY Decision Making? 9/41 Is this a normal, healthy female with eggs OR Is this a disease/abnormal situation If spring - summer and no abnormalities then husbandry improvements may be sufficient – Basking areas – Nesting areas – Quiet seclusion – Appropriate nutrition (e.g. calcium supplements). 9 5  10/8/24 INTRO PHYS EXAM CASE INVESTIGATION DIAGN IMAGING MEDICAL THERAPY SURGERY Decision Making? 10/41 Conservative treatment often fails due to – Late presentation – Large number of infertile eggs – Metabolic derangements – Infection, disease. 10 INTRO PHYS EXAM CASE INVESTIGATION DIAGN IMAGING MEDICAL THERAPY SURGERY Diagnostic Evaluation 11/41 Assessment of husbandry and nutrition – Corrective measures are often too late to be effective this year Hemtology & biochemistry – Metabolic disturbances in females? infection? Diagnostic imaging (radiography, ultrasonography) – Post-ovulatory egg stasis (dystocia) – Pre-ovulatory follicular stasis – Neoplasia – Hemipenal swelling/mass. 11 6  10/8/24 INTRO PHYS EXAM CASE INVESTIGATION DIAGN IMAGING MEDICAL THERAPY SURGERY Blood Collection 12/41 Venepuncture – Jugular, caudal/coccygeal, cardiac – Hematology Heparin chelonians, EDTA squamates Leucocytosis, heterophilia, monocytosis (azurophilia) – Biochemistry iCa, TCa, P, TP, Chol, Trigs. 12 INTRO PHYS EXAM CASE INVESTIGATION DIAGNOSTIC IMAGING MEDICAL THERAPY SURGERY Radiography 13/41 Lizards – Post-ovulatory egg stasis (eggs within oviducts or shell glands) – Pre-ovulatory follicular stasis (unshelled ova within enlarged ovaries). 13 7  10/8/24 INTRO PHYS EXAM CASE INVESTIGATION DIAGNOSTIC IMAGING MEDICAL THERAPY SURGERY Radiography 14/41 Snakes – Post-ovulatory egg/fetal stasis Shelled eggs, obvious fetuses within oviducts or shell glands – Pre-ovulatory follicular stasis Unshelled ova within enlarged ovaries. 14 INTRO PHYS EXAM CASE INVESTIGATION DIAGNOSTIC IMAGING MEDICAL THERAPY SURGERY Radiography 15/41 Chelonia – Obviously calcified eggs in oviduct (most common), bladder (rare) or free in coelom (rare) – Pre-ovulatory follicular stasis is more difficult to determine using plain radiography (CT or US required). 15 8  10/8/24 INTRO PHYS EXAM CASE INVESTIGATION DIAGNOSTIC IMAGING MEDICAL THERAPY SURGERY Ultrasonography 16/41 Useful to differentiate between soft tissues Identify and stage egg/fetal development – Healthy vs degenerating ova – Eggs – Live vs dead fetuses. 16 INTRO PHYS EXAM CASE INVESTIGATION DIAGNOSTIC IMAGING MEDICAL THERAPY SURGERY Medical Therapy 17/41 Appropriate environment, nutrition, fluid support – Temperature & nest sites – Check Ca & P **Do not give injectable Ca routinely** Induction of egg laying – Contraindicated if obstruction – Ineffective if hypocalcemic or non-receptive – Chelonia Oxytocin 1-5 iu/kg SC Dilute with saline (slow absorption) – Lizards/Snakes PGE 100 μg/kg gel into cloaca PGF2α 100 μg/kg by SQ injection Oxytocin 1-5 iu/kg SC. 17 9  10/8/24 INTRO PHYS EXAM CASE INVESTIGATION DIAGNOSTIC IMAGING MEDICAL THERAPY SURGERY Cloacal Prolapse 18/41 Prolapse – Cloaca (replace? resection?) – Phallus (replace? amputation?) – Hemipenes (replace? amputation?) – Oviduct (resection + coeliotomy) – Bladder (replace or resection + coeliotomy) – Colon (replace + coeliotomy) Keep moist – Antibiotic cream – Clear cling food wrap Reduce swelling – Hyperosmotics. 18 INTRO PHYS EXAM CASE INVESTIGATION DIAGNOSTIC IMAGING MEDICAL THERAPY SURGERY Cloacal Prolapse Replacement 19/41 Do not use purse-string sutures Transcutaneous cloacopexy – Large Q-tip inserted into cloaca and tented against ventrolateral body wall – Place 2-3 full thickness sutures through cotton tip (ensures entered lumen) – Leave long, exteriorize Q-tip, free sutures, pull ends to internalize loops, and tie Coeliotomy may also be required. 19 10  10/8/24 INTRO PHYS EXAM CASE INVESTIGATION DIAGNOSTIC IMAGING MEDICAL THERAPY SURGERY Snakes: Egg Manipulation 20/41 General anesthesia Try to manipulate egg(s) out through cloaca May need to collapse/aspirate egg contents through vent. 20 INTRO PHYS EXAM CASE INVESTIGATION DIAGNOSTIC IMAGING MEDICAL THERAPY SURGERY Snakes: Percutaneous Aspiration 21/41 Aspiration – Sterile preparation – Isolate against lateral body wall – 18-20 g needle between lateral scales Often pass collapsed egg(s) in 12-24 hours Long term retained eggs may not aspirate (inspissated) Post-op coelomitis is a risk. 21 11  10/8/24 22/41 BIRDS 22 EXCESSIVE EGG PRODUCTION DYSTOCIA History Physical Exam Diagnostic Imaging Clinicopathology Treatment 23/41 Chronic egg laying Often cockatiels! High calorific diet (seeds) Long photoperiods Mate interaction – male bird – Overly affectionate owner. 23 12  10/8/24 EXCESSIVE EGG PRODUCTION DYSTOCIA History Physical Exam Diagnostic Imaging Clinicopathology Treatment 24/41 Poor body condition Debilitated Soft doughy feel to the caudal coelom, may feel egg. 24 EXCESSIVE EGG PRODUCTION DYSTOCIA History Physical Exam Diagnostic Imaging Clinicopathology Treatment 25/41 Radiography – Shelled eggs are obvious – Hyperostosis (common) – Osteoporosis (rare) – Increase in soft tissue density in region of reproductive tract (caudodorsal coelom). 25 13  10/8/24 EXCESSIVE EGG PRODUCTION DYSTOCIA History Physical Exam Diagnostic Imaging Clinicopathology Treatment 26/41 Ultrasonography (often limited value unless air sacs compressed) – Ovary – Enlarged, hypertrophied or cystic tract. 26 EXCESSIVE EGG PRODUCTION DYSTOCIA History Physical Exam Diagnostic Imaging Clinicopathology Treatment 27/41 Hematology – Leukocytosis & monocytosis if infected/inflamed – Maybe anemia of chronic disease? Biochemistry – Hyper- or hypocalcemia (↑TCa, normal iCa) – Hypercholestrolemia, lipemia – Hyperglobulinemia – Hypo- or hyperalbuminemia – ↑ AST, ↑ CPK. 27 14  10/8/24 EXCESSIVE EGG PRODUCTION DYSTOCIA History Physical Exam Diagnostic Imaging Clinicopathology Treatment 28/41 Improvements in husbandry & nutrition – Decrease photoperiod to 8 hrs – Convert from seed to formulated diet (foraging) – Remove/decrease mate/owner interactions (no touching below the neck!) – Remove favorite toys, nest sites, etc – Rotate cage furniture and cage location – Do not remove laid eggs (use false egg?). 28 EXCESSIVE EGG PRODUCTION DYSTOCIA History Physical Exam Diagnostic Imaging Clinicopathology Treatment 29/41 Medical control – Suprelorin (deslorelin) 4.7 mg and 9.4 mg implants – GnRH analogue à persistently high GnRH leads to receptor down regulation à decrease in LH/FSH and drop in egg production – Inject SQ between shoulders, repeat early every spring (Feb/Mar in GA). 29 15  10/8/24 EXCESSIVE EGG PRODUCTION DYSTOCIA History Physical Exam Diagnostic Imaging Clinicopathology Treatment 30/41 Surgery – Permanent (unlike medical therapy) – Often better to treat with GnRH before surgery – Oophorectomy (very high hemorrhagic risk!!) – Salpingohysterectomy Prevents egg production but not ovarian activity/ovulation – Low fecundity birds = intermittent, subclinical coelomitis, generally OK – High fecundity birds = severe yolk coelomitis, usually fatal Unlikely to resolve behavioral issues Still need to instigate management changes post-op to reduce reproductive drive in the future (incl repeat GnRH implant annually). 30 EXCESSIVE EGG PRODUCTION DYSTOCIA History Physical Exam Imaging Clinicopathology Treatment 31/41 Difficulty in egg laying – Lack of nest site, unsuitable environment, malnutrition, metabolic derangement, reproductive disease May have a history of repeated egg laying Many have no reproductive history! – “What!!….he’s a girl!?!”. 31 16  10/8/24 EXCESSIVE EGG PRODUCTION DYSTOCIA History Physical Exam Imaging Clinicopathology Treatment 32/41 Most cases present as emergencies! – Dyspnea, tachypnea – Fluffed appearance, depressed – Unable to perch, lameness (neuropraxis) 32 EXCESSIVE EGG PRODUCTION DYSTOCIA History Physical Exam Imaging Clinicopathology Treatment 33/41 Examination…pre-oxygenate first if visibly unwell! – Normal to poor body condition – Coelomic distension – Egg may be palpable (don’t confuse with ventriculus?) – Dehydrated & depressed. 33 17  10/8/24 EXCESSIVE EGG PRODUCTION DYSTOCIA History Physical Exam Imaging Clinicopathology Treatment 34/41 Radiography – Single or multiple shelled eggs May appear normal, grossly abnormal, or broken! – Osteoporosis or hyperostosis. 34 EXCESSIVE EGG PRODUCTION DYSTOCIA History Physical Exam Imaging Clinicopathology Treatment 35/41 Ultrasonography – Generally possible due to severe compression of airsacs Enlargement of soft tissues Free abdominal fluid (ascites? coelomitis?) – Useful to detect non-calcified eggs – Evaluation of ovarian activity. 35 18  10/8/24 EXCESSIVE EGG PRODUCTION DYSTOCIA History Physical Exam Imaging Clinicopathology Treatment 36/41 Blood collection from jugular (excellent restraint or sedation) – Beware of volume! Hematology – Leukocytosis & heterophilia (+/- monocytosis) Biochemistry – Hypercholesterolemia, lipemia, hyperglobulinemia – ↑ AST, ↑ CPK – ↑ TCa, normal iCa 36 EXCESSIVE EGG PRODUCTION DYSTOCIA History Physical Exam Imaging Clinicopathology Treatment 37/41 Initial stabilization prior to diagnostics – Incubator Oxygen support if dyspneic Temperature 85-88oF to reduce caloric demands Humidity 80-100% Quiet with low perches, or better still provide a soft towel nest site – Therapy Analgesics (eg meloxicam, butorphanol) 37 19  10/8/24 EXCESSIVE EGG PRODUCTION DYSTOCIA History Physical Exam Imaging Clinicopathology Treatment 38/41 Medical treatment (assist egg laying, assuming no obstruction) – Cloacal lubrication (50:50 KY and sterile saline) – Injectable calcium rarely indicated (only if hypocalcemia, tetany) – Prostaglandins PG E2 gel topically into cloaca (0.2 mg/kg) – relaxation of uterovaginal sphincter & vagina PG F2α by injection (0.02-0.1 mg/kg) – ↑ uterine contractions – Oxytocin (5-10 u/kg slow IV or diluted in saline and given SQ). 38 EXCESSIVE EGG PRODUCTION DYSTOCIA History Physical Exam Imaging Clinicopathology Treatment 39/41 Procedural/Surgical options… – Episiotomy To assist delivery of large egg at vagina-vent border – Puncture egg with large needle, aspirate and then collapse – Exploratory coeliotomy Salpingotomy (endangered? valuable breeder?) Salpingohysterectomy (most pet birds) Oophorectomy rarely performed due to HIGH surgical risks – May resect or aspirate abnormal follicles – Unless oophorectomized must instigate management changes +/- GnRH implant to prevent ovarian activity. 39 20  10/8/24 Surgical Videos on ELC: Please Watch! 40/41 40 Aims & Objectives 41/41 Appreciate that reproductive issues are very common in birds and reptiles but only a few will be covered in class – Excessive egg production – Dystocia – Cloacal prolapse Be able to identify male and female of common species Be able to identify abnormal presentations and know how to undertake a diagnostic investigation Know the medical and surgical options for treatment Watch the ELC surgery videos. 41 21