ISSN 2398-2985      

Gastrointestinal obstruction

Jreptile
Contributor(s):

Sarah Brown

Robert Johnson


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.
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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.

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