Matteo Oliveri DVM, PhD

Veterinary teaching hospital. Faculty of veterinary medicine, university of

Teramo, Italy
Reptile-vet; herpetological medicine specialist group
Kura kura, sea turtle hospital. Nusa Penida, Bali, Indonesia
Reptile internal medicine

• Parathyroid: hyperparathyroidism and metabolic bone disease

• Thyroid: goiter, hyperthyroidism and hypothyroidism
• Liver: liver diseases
• Kidneys: dehydration, hyperuricemia and renal gout
• Cardiology: myocardial degeneration, valvular insufficiency, cranial vena cava syndrome
• Pancreas: diabetes (?)
Parathyroid: the PTH

• Function: regulation of the calcemia through the production of the PTH:

- the PTH impulses the calcium reabsorption from the bones through indirect
stimulation of the osteoclasts, the osteoclasts increase the calcemia at expenses of
the bone structure
- inhibits the reabsorption of phosphate (HPO42−) and increases the rabsorption of
Ca+ at level of the renal tubules (resulting in a decrease of phosphatemia and
consequently an increase of the ionized calcium, which is the readily available
form for the organism)
- another effect of PTH on the kidney is its stimulation of the conversion of 25-
hydroxy vitamin D into 1,25-dihydroxy vitamin D (calcitriol)

• Hyperparathyroidism is the most common hormonal problem in captive reptiles

Parathyroid:

• Vitamin D cycle:
Functions of the D3:
Regulation of the
bone homeostasis

Non skeletal
functions

Chih-Chien Sung, Min-Tser Liao, Kuo-Cheng Lu, Chia-Chao Wu (2012): Role of Vitamin D in Insulin
Resistance. Journal of Biomedicine and Biotechnology 2012: 2-11
Parathyroid: hyperparathyroidism

• Primary
- tumors of the parathyroid
• Secondary
- hypocalcemia
• Tertiary (after secondary hyperparathyroidism)
- parathyroid hyperplasia after prolonged hypocalcemia
Parathyroid: secondary hyperparathyroidism

• Causes of secondary hyperparathyroidism (hypocalcemia):

- renal
- hepatic
- nutritional
- environmental

• Environmental hyperparathyroidism can be due to lack of UVB

exposition, but also from unsuitable temperature since all enzymatic
reactions are dependent on temperature in ectotherms
Secondary hyperparathyroidism: symptoms

Metabolic bone disease syndrome

Muscular twitching (hypocalcemia)
Prolapses (muscular weakness)

Iguana iguana

Pogona vitticeps
Testudo marginta
 Secondary hyperparathyroidism: diagnostic
• Anamnesis:
A detailed knowledge of the thermal behavior, UVB requirement and diet of
the species is mandatory to underline possible causes of secondary
hyperparathyroidism
The secondary hyperparathyroidism, can be a consequence of kidneys and
liver failures
Biochemistry:
Calcium: normal, decreased or even high
Phosphorus: generally increased
Imbalanced Ca\P ratio
Secondary hyperparathyroidism: diagnostic

• Imaging diagnostic:
Testudo horsfieldii (Chelonia). The picture shows
an adult male T. horsfieldii presenting prolapsed
phallus and secondary hyperparathyroidism
(radiographic Figure). Severe hypocalcemia
(prelude to the secondary hyperparathyroidism)
causes a generalized loss of muscular tone
which can lead to the prolapse of the phallus
due to the relaxation of the proctodeum. Notice
the prolapsed phallus and the marbled
appearance of the bone (upon the lung field and
on the carapace), and the diaphanous
appearance of the long bones (particularly
evident in the tibia and fibula and phalanges)
signs of secondary hyperparathyroidism.
Secondary hyperparathyroidism: treatment

3 key-points:
- Restoring the calcium homeostasis: calcium gluconate IM (50-100 mg/kg) for a maximum of 4-5 doses
every 48 hours, then switch to oral administration of calcium plus D3, exposure to UVB rays, decrease
of the phosphorus intake with P-binding compounds (Ipakitine: Calcium carbonate 10% Chitosan (crab shell
extract) 8% Lactose 82%)
- Supportive treatment: fluid therapy (RL, Glu, NaCl 0,9%), B vitamin complex (including thiamine),
gleptoferrone (Fe+), force feeding (plus carnitine)
- Pain management: fentanyl patch (25 μg/h patch), changing the patch once a week (Squamata); tramadol
7-10 mg/kg IM every 24-48 hours

- Biphosphonates (???): structurally similar to pyrophosphate. The bisphosphonate group mimics

pyrophosphate's structure, thereby inhibiting activation of enzymes that utilize pyrophosphate.
Bisphosphonates accumulate to a high concentration only in bones. Bisphosphonates inhibit the
digestion of bone by encouraging osteoclasts to undergo apoptosis, or cell death, thereby slowing bone
loss.
Thyroid: anatomy and physiology

• A well-defined encapsulated gland.

• In turtles, snakes, and Sphenodon punctatus it is unpaired; in Crocodilia it is markedly bilobed.
• Wide diversity in thyroid morphology and position: in snakes it lays just cranial to the heart, and is
often surrounded by a fat pad. In iguanas the thyroid gland is bi-lobed and embraces the ventral
surface of the trachea.
 Thyroid
Common
carotid

Brachiocephalic Thyroid artery

Subclavian
trunk
artery
Brachial
artery
Pulmonary
Right aorta trunk
Left aorta

Lepidochelys olivaacea.
Aortic arches and
pulmonary trunk.
Heterodon nasicus. Normal appearance
of the thyroid gland
Thyroid: anatomy and physiology
• The basic unit of the thyroid gland is the follicle, (50 to 300 μm; Lynn, 1970). Follicles are
surrounded by a single layer of epithelial cells (follicular cells or thyrocytes) which vary
from squamous to cuboidal to columnar with increasing activity.
• Seasonal changes in histology both in relation to temperature and breeding season are of
particular interest, in the summer the follicular cells of Graptemys geographica were
columnar with reduced colloid and in the winter hibernation the follicular cells were
cuboidal with much stored colloid (Semple, 1975).
• The hypothalamus controls the hypophysis through nerve impulses and secretion of
hormones: The hypothalamus secretes thyrotropin- releasing hormone (TRH), which
stimulates the production of thyroid stimulating hormone (TSH) in the pituitary
• Photoperiod and temperature are involved in the regulation of the thyroid function.
Melatonin suppresses thyroid activity (Sarkar, et al 1997).
Semple, R.E. 1975. Seasonal changes in thyroid activity in turtles native to Ontario, Canada. J Physiol, 245 (2):115-117.

Sarkar S, Sengupta A, Chaudhuri-Sengupta S, Maiti B. 2007. Thyroid responses to altered photoperiod in the soft-shelled
turtle Lissemys punctata punctata. Acta Biol Hungarica Biol, 58(1):11-19.
The follicular cells concentrate iodides
from the thyroid’s exceedingly rich
blood supply.

Under the stimulus of TSH,

thyroglobulin molecules are
endocytosed from the colloid into the
follicle and broken down into MIT, DIT,
T3 and T4.

MIT and DIT are deiodinated and the

iodine is recycled. T3 and T4 are
protein bound and distributed in the
bloodstream to the peripheral tissues.
T4 it is converted to the more active
form, T-3, via de-iodinases.

In reptiles T4 predominates. Being

lipophlic, thyroid hormones circulate
bonded to proteins (TBP)
Thyroid: anatomy and physiology

Thyroid hormones functions: (on nearly every cell in the body)

• Increase the basal metabolic rate
• Affect protein synthesis
• Help regulate long bone growth (synergy with growth hormone) and neural maturation
• Increase the body's sensitivity to catecholamines (such as adrenaline)
• Regulate protein, fat, and carbohydrate metabolism, affecting
• They also stimulate vitamin metabolism
• They stimulate reproductive activity
• They regulate the shedding process in Lepidosauria
Thyroid: pathology of the thyroid gland
• In lizards thyroidectomy causes a cessation of shedding with a build up of the horny layer (Lynn
1970)
• Excess thyroid supplementation causes shedding to cease, and thyroidectomy increases shedding
frequency (Thamnophis, Python, Natrix, Ptyas, Chionactus) (Lynn 1970)

Gekko gecko, shedding time in days

Chiu KW and Maderson PFA (1980). Observations on the Interactions Between

Robert M. Stabler RM (1939): Frequency of Skin Shedding in
Thermal Conditions and Skin Shedding Frequency in the Tokay (Gekko gecko) 1980
Snakes Copeia 4: 227-229
JOURNAL OF HERPETOLOGY 14(3):245-254
Thyroid: pathology of the thyroid gland
Symptoms of malfunction of the thyroid:
• Thyroidectomy of Trachemys (Pseudemys) scripta significantly reduced growth rate within
6–8 weeks (Denver and Licht, 1991)
• Goiter: the enlargement of the gland, it can be toxic (associated with hormone
overproduction) or nontoxic.
• Myxedema
• Swelling of the bae of the neck and respiratory sounds (tortoises)
• Regurgitation (snakes)

Lynn GW. 1970. The thyroid. In Biology of the Reptilia, Gans, C, Parsons, J, eds., Academic
Press, London, 201-234.
Denver RJ, Licht P. 1991. Dependence of body growth on thyroid activity in turtles. J Exp Zool,
258(1); 48–59.
Corallus hortulanus.

Hypertrophic thyroid gland

(goiter) upon dissection
Thyroid: pathology of the thyroid gland

• Non toxic goiter: dietary deficiency in iodine, or the result of feeding foods high in iodine-binding
goitrogens, which are found in, cabbage, kale, broccoli, rapeseed, turnips, mustard seed,
cauliflower, Brussels sprouts, and bok choy.
Low T3 and T4 levels, along with a swelling in the neck were used to diagnose goiter in a giant
tortoise
• Hypothyroidism is an uncommonly reported disorder which is characterized by decreased
production and release of thyroid hormones resulting in decreased metabolic activity. Anorexia,
goiter, decrease in growth rate, decrease in ecdysis frequency (lizards), increase in ecdysis
frequency (snakes), myxedema of subcutaneous tissues generally involving the head, neck, and
proximal forelimbs (Geochelone nigra, Chentrochelys sulcata).
• Hyperthyroidism is characterized by a state of abnormally high metabolism resulting from
elevated concentrations of T3 and T4 produced by the thyroid gland. Increase shedding in lizards
and decreased in snakes are suggested by the experiments. Polyphagia, weight loss, loss of dorsal
spines, hyperactivity, increased aggression, and a palpable mass in the ventral cervical region are
reported in Iguana iguana.
Thyroid: diagnostic

Reference values of T3 and T4 in

reptiles; in Crysemys, Psudemys,
Deirochelys and Emydoidea
elevated blood levels of T4 are
correlated to the presence of TBP
in the blood.
Wide seasonal changings are
seen in reptiles

Boyer TH, Steffes ZJ (2011): REPTILIAN

THYROID ANATOMY, PHYSIOLOGY AND
DISEASE. In: 2011 Proceedings Association
of Reptilian and Amphibian Veterinarians.
Thyroid: treatment

• Hypothyroidism and goiter: supplementation of iodine in the diet, removal of all goitrogenic food
items, levothyroxine of 0.02mg/kg every 48 hours (Norton, et al, 1989).
TSH is another option: 3.8 U TSH/kg SC successfully risen plasma T4 in Chrysemys picta (Sawin, et
al., 1981)
• Hyperthyroidism: Radioactive Iodine-131 at a dose of 0.1mCi (millicurie) injected subcutaneously
in the ventral neck region is reported in Eublepharis macularius. Curative partial thyroid surgical
excision is reported in Iguana iguana.
• Required dietary iodine in a reptile has been estimated as one third to one quarter of that needed
in humans, and can be calculated as 0.3g/Kg BW (Donoghue, 2006)
• Checking the T4-T3 values every 21 days during treatment is strongly advised

Norton TM, Jacobson ER, Caligiuri R, Kollias GV. 1988. Medical management of a galapagos
tortoise (Geochelone elephantopus) with hyperthyroidsm. J Zoo Wildl Med, 212-216.
Donoghue S. 2006. Nutrition. In: Mader DR, editor. Reptile medicine and surgery. 2nd edition. St. Louis, MO: Elsevier Inc, P. 251-98.
Sawin CT, Bacharach P, Lance V. 1981. Thyrotropin-releasing hormone and thyrotropin in the
control of thyroid function in the turtle, Chrysemys picta. Gen Comp Endocrinol, 45:7-11.
Liver
• Bi-lobed in most reptiles, with the left lobe reduced. Right lobe bearing the gallbladder (hepatic duct connects
the gallbladder with duodenum). About 4-5% of bodyweight in most squamates
• The chelonian liver is large and traverses the cranial coelom. The smaller, left lobe is connected to the concave
side of the stomach by the gastrohepatic ligament, and the right lobe is attached to the duodenum by the
hepatoduodenal ligament
• In crocodilians, the liver occupies a large portion of the cranial to mid coelomic cavity, more so on the right.
During inspiration, the liver is pulled caudal through the action of the abdominal muscles allowing the lungs
to expand.
• The reptilian hepatocyte shares many similarities with its
mammalian counterpart, and there are 3 additional
main cell types that form the hepatic sinusoids:
the endothelial cells, macrophages (including Kupffer cells),
and stellate or Ito cells.
• The liver synthetizes the vitellogenin stimulated by estrogens
during folliculogenesis

Trachemys scripta elegans.

Liver during the vitellogenesis
Heterodon nasicus, dissected
liver, ventral surface
 Gallbladder

Lepidochelys olivacea
Bile duct

Duodenum

Pancreas
Liver: physiology

Relevant functions of the liver:

- Glucose supply (glucose synthetized from glycogen through glycogenolysis, or from
lactate, pyruvate fats and amminoacids through gluconeogenesis); 25 to 150 mg/dl
GLU is the range in reptiles.
- Fat storage for hibernation, hepatic storages of fat are higher prior to hibernation
and fall right after the hibernation, fat storages are higher in females than males
(vitellogenesis)
- Exports phospholipids and cholesterol
- Synthetizes bile acids, being the 3α hydroxyl bile acid present in all studied taxa.
- Most reptiles lack biliverdin reductase, however snakes do produce bilirubin,
particularly Drymarchon sp. Contains 10 times more conjugated bilirubin than any
other species of snakes (Divers, 2017)
Liver: physiology

• Syntethizes albumin, which is required as a carrier of many endogenous and

exogenous substances like the calcium
• Metabolizes proteins through the ornithine-citrulline-arginine cycle
producing urea, which is mostly excreted by the kidneys (further
transformed in uric acid in many terrestrial species).
• Urea production tends to be more important in chelonians and crocodiles,
particularly in aquatic species.
• The amount of ammonia, urea and uric acid values is affected by the
humidity of the environment in which the species evolves, being the
ammonia and urea more represented in the blood of the animals living in
humid or aquatic environments
• Estrogens receptors have been detected in the liver of Chrysemys picta,
estrogens regulates the vitellogenesis cycle in the liver.
Hepatic diseases: diagnostic

• Clinical presentation:
- Icterus (in those Squamata that produce bilirubin); biliverdin in feces
- Ascites (late stage presentation)
- Anorexia
- Neurologic symptoms

• Hepatic lipidosis should be suspected in all obese reptiles undergoing a

period of anorexia
Hepatic diseases: diagnostic
• Biochemistry (acute phase):
- ALT, AST, ALP, GGT and SDH are commonly used in human and small mammals
medicine as an assessment of the liver function, however moderate activity of AST
and SDH were detected in many reptilian tissue including muscles
- In Green iguana, following acute hepatic insult, ASD, SDH and LDH increased 15
folds, while ALP increased 4 folds (Schnellebacher, 2016)

Petrosky KY, Knoll JS, Innis C (2016): TISSUE ENZYME ACTIVITIES in Kemp'S RIDLEY TURTLES (LEPIDOCHELYS
KempII). Journal of Zoo and Wildlife Medicine, 46(3):637-640
Bogan Jr. JE, Mitchell MA (2014): Characterizing Tissue Enzyme Activities in the American Alligator
(Alligator mississippiensis). Journal of Herpetological Medicine and Surgery 24: 78-81
Hepatic diseases: diagnostic

Bile acids are commonly used as marker of hepatic and biliary malfunctions, the 3α hydroxyl bile acid is the
target of most of the commercial tests.

Divers SJ: THE REPTILE LIVER: ANATOMY, PHYSIOLOGY, CLINICAL DIAGNOSIS, AND GENERAL APPROACH TO, TREATMENT. In: proceedings of
the ICARE international congresss, Venice, Italy, 2017
Hepatic diseases: diagnostic
Hepatic diseases: diagnostic
• Ecography:
Liver is generally homogenous, with a lower echogenicity compared to
fat bodies. Lobulation is uncommon; in lizards, chelonians and
crocodiles the right liver lobe hosts the gall bladder, which is hypoechoic
and shows thin and smooth walls; in snakes the GB Is separated from
the liver and is in contact with the spleen and the pancreas in
correspondence of the duodenum. A detailed comprehension of the
anatomy of the species is required for diagnosis of any hepatic illness.
Hepatic diseases: diagnostic

• Furcifer verrucosus: echography

Furcifer verrucosus: echography
Hepatic diseases: diagnostic

• Radiography
- Size and radio-density of the liver
- Presence of ascites
- Size and appearance of the gallbladder

Iguana iguana, ascites

Radiography
- Furcifer pardalis
- Distention of the gallbladder
Hepatic diseases: treatment

• Fluid therapy: ringer lactate, glucose and 0,9% NaCl

• Lactulose: increases acidification of the colon content, enhancing the proliferation of the lactobacilli at
expenses of the ammonia-producing bacteria (E. coli). The acid environment facilitates the conversion of the
NH3 into the less toxic NH4+ (ammonic ion).
• Antioxidants:

Divers SJ: THE REPTILE LIVER:

ANATOMY, PHYSIOLOGY,
CLINICAL DIAGNOSIS, AND
GENERAL APPROACH TO,
TREATMENT. In: proceedings
of the ICARE international
congress, Venice, Italy, 2017
Cardiology: anatomy

• Heart represent the 0.2% to 0.3% of the BW.

• Three chambered organ
- two atria and one ventricle
- sinus venosum (atipical four chambered organ)
- well developed coronary sulcus.
• There is no complete interventricular separation,
but an incomplete muscular ridge Lepidochelys olivacea.
(Squamata and Chelonians)
• Endocardium and epicardium
• Miocardium is formed by three layers
- thin layer of longitudinally arranged cells
- spirally arranged miocytes
- inner spongy layer
• Intracardiac blood flow: (cavum venosum, arteriosum,
polmonale)
 Thyroid
Common
carotid

Brachiocephalic Thyroid artery

Subclavian
trunk
artery
Brachial
artery
Pulmonary
Right aorta trunk
Left aorta

Lepidochelys olivaacea.
Aortic arches and
pulmonary trunk.
Calluma parsonii. Detail of the coelomic
cavity; common abdominal aorta and epatic
vein.

Costal arteries

Portal vein Common aorta

Cardiology: anatomy (the senum venosum)

• In the dorsal aspect of the right atrium

• Incomplete septum divides the senum in Squamates.
• Convergence of right precava, left precava, postcava
(Squamata)
convergence of right precava, left precava, postcava
and epatic vein (Chelonia)
precava, postcava and jugular vein (Crotalus durissus)

Crocodylus niloticus
Venous system of the neck of a dissected
Eublepharis macularius. The jugular veins are
divided and paired. As they run cranially they
form the right external jugular vein (REJV), the
right internal jugular vein (RIJV), the left external
jugular vein (LEJV) and the left internal jugular
vein (LIJV). Both the internal jugular veins run
deeply into the neck, they will abruptly bend to
the center as they approach the senum venosum
joining there the external jugular veins and
forming two venous trunks, these are the left
vena cava anterior (LVCA), and the right vena
cava anterior (RVCA). The LVCA turn to the right
embracing the RVCA before to enter the senum
venosum. (A): hyoid apparatus; (B): trachea; (C):
REJV; (D): RIJV; (E): LEJV; (F): LIJV; (G): LVCA; (H):
RVCA; (I): senum venosum; (L): ventricle; (M):
right atria (being the hearth rotated to the left);
(N): posterior vena cava.
Cardiology: pericardium

• In fresh water turtles is filled with alcaline

fluid ( Calcium and Magnesium) to contrast
the acidosis of the miocardium during
prolonged apnea
• Sea turtles possess a consistent amount of
pericardial fluid. Caiman crocodylus

• Snakes don’t possess the gubernaculum

cordis

Gonyosoma oxycephalum
Cardiology: pathology

Metabolic derangements involved in cardiac diseases (non infectious)

• Renal failure:
- acidosis and hyperkalemia: can exert negative inotropic activity because excess protons compete
with calcium ion binding causing life treating arrhythmias
- hyperuricemia: excess of circulating uric acid can deposit in soft tissues including myocardium
- secondary hyperparathyroidism: tissue mineralization, calcification of large vessels (aorta)
• Obesity:
- arteriosclerosis
- atherosclerosis: vascular endothelial dysfunction caused by the oxidation of low density
lipoproteins, cholesterol or both
• Aneurysms: jugular vein in Pogona vitticeps, vascular in Liasis (Morelia, Simalia) amethistinus,
Crotalus atrox
• Cadiomegaly: due to increased pressure, idiopathic
• Valvular dysfunction: secondary to respiratory disease (snakes), congenital, idiopatic
• Pericardial effusion
Naja siamensis cranial vena cava enlargement and hemorrhage in the cervical region probably
due to the rupture of aneurysm
Cardiology: symptoms

• Anorexia, apathy
• Respiratory symptoms
• Cranial vena cava syndrome
(gular edema)
• Increased profile of the heart (snakes),
do not confuse with goiter
• Regurgitation (snakes)

Malayopyhton reticlatus. Photo

of courtesy Dr. Puveantan
Cardiology: diagnostic (blood analysis)

Venous blood analysis (sea turtles)

pH 7.4
pCo2 20-30 mmHg < 20°C
pCo2 30-40 mmHg > 25°C
po2 70-80 mmHg
Potassium (k) 4.3-5 mmol/L
Bicarbonate 25.7 mmol/L

Spievogel CF, King L, Cavin JM, Tlusty M, Silverstein D, Michelle L, Innis CJ (2017).
Use of positive pressure ventilation in cold stoned sea turtles: 29 cases (2008-2014). Journal of Herpetological Medicine and Surgery, 27: 48-57

Biochemical values commonly related with myocardium lesions

Enzyme (heart) Other tissues B. constrictor P. vitticeps G. agassizii A.mississippiensis

AST (U/L) Muscles 35 (3-331) 27 (0-77) 41-106 314 (+- 158)

LDH (U/L) Kidneys 235 (16-877) 304 (35-628) 25-250 522 (+-541)
CK (U/L) Muscles 526 (53-1728) 1211(59-7000) 2262 2663 (+-2493)
ALP (U/L) Intestine 287 (43-1342) 151 (15-447) 43-107 46 (+-29)

Carpenter JW, Klaphake E, Gibbons PM (2014). Reptile formulary and laboratory normal.
In: Mader D and Divesr S (Eds). Current therapy in reptile medicine and surgery. Elsevier Saunders, S. Louis, MO. Pp: 382-410
Cardiology: diagnostic (ECG)

• Electrocardiography is a useful and noninvasive diagnostic method of

cardiac illnesses in reptiles

Scheme of the lead positioning

in snakes (lead). Image of
courtesy Ana Zemanova,
university of Brno.
Cardiology: diagnostic (ECG)
• P: depolarization of the atria
• Q: depolarization of the ventricular septum
• R and S: depolarization of the ventricle
• T: repolarization of the ventricle
Iguana iguana ECG values: non sedated animals. Courtesy of
Ana Zemanova, Brno university.

Bothrops asper, lead 2 Eithnoven triangle.

Bogan (2017)
Cardiology: diagnostic (ECG)

Chamaeleo calyptratus ECG values: non sedated animals.

Courtesy of Ana Zemanova, Brno university.
Cardiology: diagnostic (ecocardiography)
Cardiology: treatment

• Acidosis and hyperkalemia:

- Furosemide and fluids
- Ringer lactate to buffer acidosis
- Spironolactone
• Hyperuricemia:
- Allopurinol
- Fluids
• Secondary hyperparathyroidism:
Treatment as aforementioned
• Obesity: diet and movement. Pay attention to the condition of the liver.

Others: inotropic agents, ACE inhibitors, β1 blockers (atenolol, acebutol, betaxolol, bisoprolol,
celiprolol, metoprolol, nebivolol, esmolol; no dosages nor adverse effects data available)
Cardiology: treatment

• Iguana iguana 13 years old female, gular edema, anorexia weakness:

- pericardial effusion, hyperecogenicity of the myocardium, possible AV valvular regurgitation,
mineralization of the aortic arch.
Therapy day one
spironolactone diuretic (aldosterone agonist)
benazepril ACE inhibitor
pimobendan inotropic agent
Therapy day two
propentophilline perfusion of the myocardium
furosemide diuretic (proximal tubules)
fluid + b complex

Treatment followed for over one year and half, posology variate with the time. From every day
(alternate), to twice a week.
Cardiology: treatment

Iguana iguana. Therapeutic plan for myocarditis and cardiomegalia. Courtesy of Dr. Eva
Cermakova and Ana Zemanova, Brno university.
Nephrology: anatomy

• Kidneys are located in the caudal abdominal cavity, more or less

caudally depending on the taxa
• They are bean shaped in turtles and crocodiles. Elongate and lobulated
structures in snakes. The right kidney is generally located cranial to the
left one (particularly in snakes)
• Ureters emerge from the ilum in the ventral part of the kidney, and
they accompany the sperm ducts or the oviducts until the urinary or
urogenital papillae in the urodeum
Furcifer pardalis. Kidneys, colon,
testicle and fat pad.
Nephrology: anatomy
• Functional structure: glomerulus (perfusion is variable
according to the hydration status)
- proximal tuble (30 to 50% of water reabsorbed)
- intermediate segment
- distal tuble
- collecting duct
• Perfusion: blood is supplied by renal arteries (branching off the
dorsal aorta).
• Porto-renal system: blood flows from the tail (caudal vein) and
the legs (iliac veins) to two different renal veins that drive the
blood to a net of capillaries that perfuse the renal tubules. Naja sp. Elapidae. The parietal layer (PL) of
Bowman’s capsule of a renal corpuscle is
- dehydration causes the decrease of the glomerular perfusion continuous with the short neck segment
(to save water). This lead to an increased chance of (NS) of the nephron. Connective tissue
accumulation of uric acid and renal failure. (linked to the low (CT) in the center of the glomeruli stains
diastolic pressure 20mm Hg) positive.
-> however the tuble are perfused by the capillary net coming Proximal tubules (PT) have brush borders
from the porto-renal system and cytoplasmic granules. (Jacobson,
2007)
Nephrology: physiology
• Excretion of nitrogen wastes:
depending on the species, and the
environment in which the animal
evolved, reptiles can excrete uric
acid, urea or ammonia
• Reptiles lack loop of Henle, hence
they cannot concentrate the urine
above the plasma osmolality

Divers SJ: urology. In: proceedings of the ICARE

international congress, Venice, Italy, 2017
Nephrology: physiology
• Glomerular filtration rate: decrease in the GFR is an evolutionary consequence to the lack of the
loop of Henle. Instead of concentrating urine, reptiles decrease the amount of urine produced in
order to save water
• The overall GFR is mediated by changes in the number of filtrating glomeruli rather than a variation
of FR in each glomerulus
• Hydration dramatically influences the GFR: Hemidactylus mabouia GFR ranges from 3,33 ml/kg/HR
in dehydrated subjects, to 24,3 ml/kg/HR in water loaded subjects

Species GFR ml/kg/HR

Iguana iguana 16.6 +- 3.9
Tiliqua scincoides 15.9 +-1.0
Lepidochelys kempii 12.6 +-2.2
Crocodylus acutus 9.6 +-1.0 Normal glomerular filtration rates of different reptilian taxa
Nephrology: pathology
• Dehydration is the leading cause of renal malfunction in reptiles, in fact when the pressure
decreases at level of the glomerulus, the tubule collapses. If the pressure is not restored, the
collapsed tubules may become ischemic and finally necrotic. Moreover, the low diastolic pressure
typical of reptiles exacerbate the risk of ischemic damage in a dehydrated kidney
• Visceral gout and mineralization of kidneys are common in reptiles
• Renal secondary hyperparathyroidism
• Anorexia, reluctance to move, sunken eyes (chelonians and lizards) and decreased production of
urines are common symptoms of renal diseases.
- Chelonians: paraparesis of the rear limbs, hypotonic cloaca, constipation, prolapses in
chelonians are due to the compression of the sciatic and obturator nerve by the
hypertrophied kidneys
- Chameleons: decreased muscular tone of the tail and constipation are due to the
compression of the caudal nerve and the mechanic blockage of the pelvis by the
hypertrophied kidneys
- Iguanas: constipation and intestinal bloating are due to the mechanic blockage of the
pelvis by the hypertrophied kidneys
Nephrology: diagnostic
• Blood biochemistry:
- Elevated phosphorus
- Reduced Calcium/Phosphorus
ratio
- Increased Uric acid
- Increased GGT (from the brush
border of the proximal tubules)
- Decreased circulating 1,25 OH-D3
Furcifer verrucosus
• Hematology:
Species PCV (HTC)
- Increased hematocrit
Pogona vitticeps 30 (19-40) %
- Anemia
Morelia spilota 25 (10-46) %
Emydura spp 24 (18-30) %
Alligator mississippiensis 24.7 (12-38) %
Nephrology: imaging diagnostic
Echography proven to be useful in detecting mineralization and renal gout in
reptiles:

Heterodon nasicus, hyperechoic deposits in

the renal parenchima
Iguana iguana, uric acid deposits in
kidneys. Imges: Dr. Eva Cermakova
Nephrology: imaging diagnostic

• Radiography can be useful to evaluate

size and opacity of kidneys.

Furcifer pardalis, normal appearance of the kidneys

Nephrology: other diagnostic methods

• Urinalysis
• Scintigraphy (technetium)
• Endoscopy
• Biopsy
• GFR evaluation
• Advanced imaging diagnostic (CT scan and MRI)
Nephrology: treatment
• Fluid balance and hydration:
- Fluid therapy: ringer lactate, glucose and 0,9% NaCl (depending on the biochemistry), 20 to 30 ml/kg
• Hyperuricemia:
- Allopurinol oral 25 mg/kg daily to decrease uric acid production; probencid and sulfinpyrazone can increase
the UA excretion
• Glomerular Filtration Rate
- Furosemide 2-5 mg/kg daily acts upon the proximal tubule decreasing the reabsorption of sodium and
increasing the GFR
• Hyperphosphatemia:
- Ipakitine (lactose, calcium carbonate, chitosane) administered together with the food can decrease the
phosphorus dietary intake, oral calcium is also advised

Renal diseases, particularly when mineralization and secondary gout are involved, are tremendously painful. Pain
management is mandatory: tramadol 7-10 mg/kg; buprenorphine 0,02 mg/kg; fentanyl patches 25μg /kg replace
once a week
Nephrology: dietary management
• In general the goal is to decrease phosphorous and proteins respecting the dietary needs of the
patient
- Force feeding: dilute carnivore care for carnivores; 60-70% herbivore care for omnivores (Emididae
etc.), mixed with omnivore care

Divers SJ: urology. In: proceedings of the ICARE

international congress, Venice, Italy, 2017
Pancreas
- located in the mesenteric border of the duodenum. Cells are intermingled with no
distinction in to endocrine pancreas and exocrine pancreas.
- in snakes is triangular in shape and is associated with the spleen, in chelonians and lizards is
elongated (in pleurodirian is separated from the spleen). In crocodiles it follows the
duodenum creating a loop in the small intestine.

Corallus hortulanus. Spleen and pancreas tightly

associated and in close proximity with the
duodenum
Lepidochelys olivacea
Pancreas
 Chelonoidis carbonarius, poluria and
polydipsia

Chelonoidis carbonarius, moderate

intestinal impaction
Pancreas

Chelonoidis carbonarius
• Asthenia
• Depression and reluctance to move
• Polyuria and polydipsia
• Hyperglycemia (Glu: 49,2 mmol/L) responsive to
the administration of 2 IU/Kg of insulin every 48h
and every 72 HR after the first week
• Diabetes (?)
Conclusions
• You cannot diagnose what you don’t know
• Physiology and anatomy are the key to understand internal medicine
• Biochemistry and hematology are fundamental to start a therapy
• If an organ exists, it can fail and cause a disease
• The lack of reference is not an excuse to avoid a test in reptile
medicine
• If you don’t know the biology of an animal, refer it to someone who
does, if this is not possible, use common sense
Thanks for the kind
attention