Thomas H. Boyer, DVM, DABVP, Reptile & Amphibian Practice

Pet Hospital of Penasquitos

9888-F Carmel Mountain Road, SD, CA

858-484-3490

www.pethospitalpq.org

Dr. Boyer

1985 UC

1989 DVM CSU

1991 ARAV

1994, 1998 AAHA books

1991-2008 Editor-in-Chief, BARAV, JHMS

1999 bought PHP

2007 AAHA accredited

2011 Diplomat ABVP

BARAV & JHMS

Diagnostic Challenge

History – If owner feels something wrong, there generally is. Must know husbandry.

PE - Do not delay workup

Bloodwork – CBC, chemistry panel, protein electrophoresis, thyroid

Fecal – Direct & Flotation

3 view radiographs

Laparoscopic biopsies

Dorsoventral view

Lateral Horizontal beam

Anterior Posterior Horizontal

Horizontal beam

SubCarapacial Venous Plexus SCVPSupravertebral sinus

Subcarapacial venous plexus

Dorsal recumbency

Surgical prep – watch eyes

Needle size, stabilize

Watch for lymph contamination

Jugular venipuncture with butterfly catheter

African species – Use Telazol!

Upper Respiratory Tract

Desert tortoise heads A – Longitudinal section

• B - Transverse section

Nasal cavity leads to choanae, contains dorsal olfactory epithelium, ventral mucous epithelium

With Mycoplasma – Nasal cavity fills with exudates, loss of mucosal glands, infiltrates of LC’s & HC’s, olfactory mucosa infiltrates of HP’s, breakdown of tissues, debris

Mycoplasma agassizii, M testudineum

Clinical signs – Clear serous to tenacious mucous nasal discharge, bubbling, clogged nares, nare erosion, rhinitis, caseous blockage, palpebral edema, conjunctivitis, decreased appetite, weight loss, death

Extremely contagious via nasal exudates, horizontal, direct or short distance (< 0.5 m)

Indirect & vertical unlikely

More common in winter

DiagnosisClinical signs suggestive – Push head into

shell, nasal discharge abnormal!

DDX – Herpesvirus, iridovirus, IN cocidiosis, oronasal fistula, nasal foreign body, GI impaction & regurgitation

ELISA Ab test (serum, > 8 wks), PCR (discharge) U of FL

Culture – Not rec’d

Differential diagnoses

Mycoplasmosis TreatmentSanibel Island - Untreated mortality 30% (50%?)

Antibiotics for 3-6 weeks

Enrofloxacin, danofloxacin, clarithromycin, tetracyclines

Neomycin-Polymyxin B-Dexamethasone nasal drops for 3 weeks

Nasal flushes

Supportive care if indicated

Isolate from other tortoises, chronic carriers

Relapse common but less severe

Nasal flushing

Pack cotton ball over glottis

Pack cotton ball over glottis

Flush each nare with 1:10 enrofloxacin:saline

Flush mucous out of nares

Note thick mucous

Chronic malnutrition Dietary history & R/O other disease

Hypoalbuminemia < 1.0 mg/dL (normal DT > 2.5 mg/dL) or anemia (PCV < 15%)

Suggestive for hepatic lipidosis or other chronic disease – mycoplasmosis, intestinal impaction, bladder stones

Dx – Endoscopic liver biopsy

Tx – Based on underlying ds, will need esophagostomy tube , no surgery until liver recovered

Esophagostomy tube

Nutritional secondary hyperparathyroidism

Dietary history

Small tortoises – Fail to grow or gain weight, soft shell, splayed legs, fail to lift plastron while walking, poor to no appetite

Prognosis

If not eating don’t survive (kidney failure?)

If eating much better prognosis

NSHP – Soft shell

NSHP – Failure to grow, upturned marginals, legs splayed out, increased vertical bridge growth

NSHP- Legs spayed out, not lifting plastron, soft shell, increased vertical growth

Nutritional secondary hyperparathyroidism

Adult onset

Shell usually solid

New growth abnormal –Marginals curl dorsally, increased vertical growth of bridge, don’t lift plastron well while walking, anterior maxillae curves - parrots beak, penile prolapse, shell too small

NSHP – Abnormal growth in seams

Parrots Beak

Parrots Beak

NSHP - Penile prolapse

NSHPAll tortoise’s shells should feel solid, like skull, even in young turtles (≈ 1 yr)

Exception –Pancake tortoise

Poor bone density – Coracoid, pubic bones

Normal vs. NSHP

Shell Trauma Dog gnaw trauma Stabilize patient, AB’s, pain

meds, nutritional, fluid support, th0roughly clean & flush wounds, wet to dry bandages,

Once stable & wounds clean (1 wk) repair shell fractures with metal wires, bridges, suture, 5 min epoxy & polypropylene gauze

Severe cases often fatal

Shell TraumaCoelomic punctures most serious, no pneumothorax

Shell heals inside out, new shell forms under damaged shell

Chelonians capable of regenerating most of shell

Oxyurids - 5 genera, 12 sps

Pathogenicity debatable

Direct life cycle –super infection?

Normal flora

• Treatment Fenbendazole on food or via ST SID x 5, repeat tx in 2-3 wks

• Per cloacal

• Ivermectin toxic in chelonians

Overgrown Rhamphotheca

Beak trim - Use Telazol

Underlying inadequate nutrition Hepatic lipidosis?

Cystic calculiUric acid & ammonium acid urate

Generally palpable

Predominate in left lobe of bladder

Inappropriate diet & lack of access to water

Definitely a problem

Obstruct or torse colon, bladder necrosis or torsion, gradual decline, weight loss, death

Cystic calculi

Cystic calculi

Torsed cecum (left), necrotic, torsed bladder lobe with urolith (right)

Intestinal impactions Ca deficient diet – Will seek rocks

Anorexia, listlessness, lack of defecation, regurgitation, straining to defecate

Small amounts of gravel in GI tract normal as long as appetite & defecation normal

Most commonly at distal transverse colon as it turns posteriorly into descending colon (caudal left coelom)

If eating – Pysllium fiber on food or via ST, repeat rads q 2 -4 wks

GI Anatomy – Belly up

Rock Sand

Decomposed Granite Sand, grass & rock

Distended loops of bowel in lung field

Total obstruction

Egg retention Palpable in inguinal fossa

Female often pacing, several false nests

Oxytocin

1- 3 tx’s q 90 min

Calcium, fluids

Make sure area to dig

Celiotomy if not responsive except if egg in pelvis

Break down, extract per-cloacally

Corneal ulcers Squinting, rubbing forelimb at eyes

Foreign bodies – Sand, hay, foxtails

Bacterial or fungal infection

Anesthetize, flourescein stain, debride, flush, tarsorrhaphy (10 - 20 days)

Cytology

Topical & systemic antibiotics & pain meds

Chelonians have no NL duct

Post-hibernation anorexia Hibernation emergence is common time for other ds.

to manifest – Mycoplasmosis, hepatic lipidosis, renal ds.

More common in northern latitudes

Hibernation - Tortoises should loose < 6-7% BW (1%), < 3 months, soak q 2 wks

Should start eating, drinking, urinating within 1 wk of emergence, no urination poor prognostic sign

Workup – CBC, Chem panel, PE, urinalysis, rads, fecal

Post-hibernation anorexia Abnormalities – Hyperuricemia, hyperkalemia,

hypoglycemia, hypoproteinemia

UA > 34 mg/dl, K > 35 mg/dl will die

Acidic urine

Treatment – Directed at underlying ds., AB’s

Fluids via ST, epicoelomically, intracoelomically until urinating well

Shallow lukewarm water soaks BID

Anorexia – Esophagostomy tube

Retained follicles Follicles that fail to ovulate or undergo atresia remain

stagnant for months become necrotic, inspissated, or rupture & cause egg yolk coelomitis

Females often anorexic w/ hepatic lipidosis

Chemistry – Elevated Ca, Alb, TP, AP

CBC – Anemia with heteropenia

DX – Celioscopy or US

Tx – Oophorectomy, supportive care. Avoid CI’s

Plastronal celiotomy

Endoscopic flank incision

Plastronal Celiotomy Oophorectomy

Oophorectomy

Oophorectomy

Oophorectomy

Breakfast?

Protozoans & Amoeba Trichomonads, monocercomonads, hexamitans

Anorexia, polydipsia, diarrhea, renal ds.

Responds to metronidazole

• Amoeba –

Causes weight loss, serious ds

Tx’d with Flagenase 400 Pediatrico (metronidazole & iodoquinol) via esophagostomy tube

Repeat fecals after tx to gauge efficacy

Ectoparasites Ticks are rare, don’t see in San Diego

Amblyomma ticks harboring heart water disease, Erlichia ruminatum, found in environment around imported tortoises in FL

2000 - Ban on importation & interstate sale of Geochelone pardalis, G. sulcata, Kinixys

Later determined tortoises were not a heart water vector

Herpesvirus Necrotizing stomatitis,

glossitis, pharyngitis, diptheritic plaques, nasal discharge, anorexia, cachexia, rapid death (esp. w/ die offs)

Eosinophillic intranuclear inclusions

Russian tortoises, Testudo horsfieldi – Carrier?

Acyclovir PO TID x 21 days. E-tube

Herpesvirus

Alphaherpesvirinae Herpesvirus of

tortoises

Fibropapillomatosis

Grey patch disease

Lung eye tracheal ds.

Hepatic necrosis in freshwater turtles (Clemmys, Chrysemys, Graptemys)

Intranuclear coccidiosisRare, unidentified species of Coccidia

Contagious fatal epidemic disease

Sudden death, rapid weight loss, weakness, gasping respiration, swollen erythematous, necrotic cloacal crusts. Gets into all tissues.

Diagnosis typically post-mortem

PCR UFL

Exuberant epiplastronMale Geochelone

sulcata, Gopherus agassizii

Dx & Removal rarely indicated

Only remove if interfering with eating

Amputate sterilely, seal with polypropylene gauze & epoxy

DrowningFound at bottom of swimming pool

Can survive long periods underwater

If unsure alive – ECG or Doppler US

Hold head down, pump legs, IPPV

Ab’s for 3 wks

Furosemide not effective in reptiles (no loop of Henle)