Regurgitation in a cockatoo

10 Regurgitation in a cockatoo




INITIAL PRESENTATION


Regurgitation and haematochezia in a bare-eyed cockatoo (or little corella).



Introduction


As avian species hide signs of illness, the onset of clinical signs is often acute, regardless of whether the disease process is acute or chronic. Supportive care is vital in patients that are unwell. This case demonstrates the need for a complete investigation to diagnose the underlying condition.



CASE PRESENTING SIGNS


A 15-year-old male little corella (Cacatua sanguinea) (Box 10.1) presented with acute onset regurgitation, haematochezia/melena, lethargy and inappetence.



BOX 10.1 Ecology of cockatoos



• The bare-eyed cockatoo (also known as the little corella) belongs to the sub-family Cacatuinae, the white cockatoos.

• They are native to Australia. In the wild, they congregate in flocks of up to several thousand birds. They are diurnal, roosting overnight in trees and foraging in daylight. They chew bark off the trees in which they perch.

• The free-ranging diet comprises mostly seeds including cereal crops, and the birds feed mostly on the ground.

• Although experienced breeders may be able to differentiate sexes by size of head/body, they are generally considered sexually monomorphic. As such, sex determination requires either DNA sampling (from blood or feather pulp) or surgical sexing by endoscopy.

• In the wild, they may bathe in the rain (hanging upside down or flying around) or flutter in wet leaves of trees.

• One individual was reported to have lived 46.9 years in captivity.

• Housing in captivity usually comprises either an aviary or a large cage with regular exercise in a larger space such as a room.

• Diets offered to captive parrots are often seed-based, but this may lead to malnutrition. It is usually more appropriate to base the diet on a formulated pellet feed with additional fresh fruit and vegetables.


Husbandry


The cockatoo had been rescued by the current owner while still a juvenile. Historically it had chronic feather damage associated with parental mutilation when a chick. The diet was mainly seed-based but with fresh fruits added. The cockatoo was caged on its own, but shared airspace with other parrots (there had been no new additions in the previous 6 months).



Case History


On the day prior to presentation, the cockatoo regurgitated once. Frank blood had been present in the faeces. On the day of examination, the faeces was almost black (Box 10.2). The owner reported him to be lethargic and inappetent (Box 10.3).



BOX 10.2 Components of normal bird droppings



• Urine: clear liquid

• Urates: white/off-white insoluble, uric acid is the major nitrogenous waste in birds

• Faeces: colour and consistency will vary depending on species and diet fed, usually dark green or brown.


BOX 10.3 When should you investigate an ill bird?


Many factors will assist with this decision.


• Client financial considerations are often important, although many pet birds are now insured.

• As prey species, parrots often conceal signs of illness until they are severely compromised. For this reason, it is usually advisable to investigate any ill health and obtain a diagnosis to enable appropriate treatment to commence as soon as possible.

• In some instances, the bird will be severely compromised (e.g. in collapsed individuals) and supportive care should be given to stabilize the patient before further investigation. Excessive handling (even for a thorough examination) in these birds may well result in more rapid demise than if the pathology was permitted to run its course. Owners should be warned of the risks associated with handling such individuals.


Clinical Examination


Some weight loss was noted since the previous examination (weighing 586 g, compared with 612 g 3 months earlier). The rhinotheca (sheath of the upper beak) was slightly overgrown, although not sufficiently so as to result in difficulty prehending food. Some ‘clicks’ were auscultated over the ventral abdominal region but as there was no evidence of dyspnoea it was suspected these related to organomegaly rather than respiratory disease. As with many avian patients, it was difficult to assess demeanour during the consultation – during this time the cockatoo appeared bright, alert and responsive. After admittance and settling into the hospital, he did become more quiet and lethargic.



CLINICAL TIPS



Assessment of bird demeanour



• If a client advises that their pet bird is quiet or subdued at home, believe them!

• It is in a bird’s best interests to hide signs of illness, and many will rally to create a false impression of health in a novel environment (your consulting room).

• If possible, it is useful to visit the bird in its home environment to observe natural and relaxed behaviour – this will give a truer impression of the bird’s demeanour.


DIFFERENTIAL DIAGNOSES


Lethargy is a vague clinical sign and can be attributed to general ill health in a bird.


The differentials for vomiting or regurgitation are:


• Ingestion of irritants (e.g. certain houseplants) or rancid food

• Gastrointestinal infection (more likely upper tract): bacteria, fungal/yeast (e.g. candidiasis [Candida albicans], megabacteriosis [Macrorhabdus ornithogaster]), protozoa (trichomoniasis)

• Diseases affecting gastrointestinal motility: toxicity (e.g. lead, zinc), proventricular dilatation disease (PDD, caused by avian bornavirus)

• Foreign body in gastrointestinal tract (GIT), particularly upper GIT (crop or in oesophagus at thoracic inlet)

• Other causes of gastrointestinal obstruction, e.g. neoplasia

• Acute metabolic disease, including causes of dehydration or polydipsia

• Renal failure

• Hepatopathy

• Pancreatitis

• Septicaemia

• Motion sickness

• Goitre (in budgerigars with iodine deficiency).

Blood in droppings may originate from urine, faeces, the reproductive tract or the cloaca. Haematuria is produced in renal disease, commonly with toxicity or neoplasia; if seen transiently after restraint, haematuria may relate to fragile blood vessels associated with hepatic or gastrointestinal disease. If blood is present in the droppings separate from the faeces or urine, it originates from either the reproductive tract or cloaca.


The differentials for blood in faeces (fresh or changed) mainly pertain to hepatic or gastrointestinal disease, and include:


• Severe bacterial or viral gastroenteritis

• Severe parasite infection: protozoa (e.g. Giardia), nematodes (unusual, more commonly seen in birds in outside aviaries with contamination from wild birds)

• Heavy metal toxicity (lead, zinc) may result in frank blood or haemoglobinuria

• Coagulopathy, e.g. associated with hepatopathy

• Haemorrhage from gastrointestinal neoplasia, including papillomas (in South American psittacines – diagnosed by cloacal examination)

• Intestinal haemorrhage associated with a foreign body, e.g. with necrosis or rupture

• Reproductive disease or cloacitis may cause haematochezia

• Blood in faeces may originate from meat products in the diet of some birds

• Melena is commonly seen in cases of advanced hepatic disease, gastrointestinal ulceration or starvation. Less common causes include gastric and hepatic adenocarcinoma or pancreatitis.


Case Work-Up


It is important to identify and correct the underlying cause of the clinical signs to enable long-term treatment.



Supportive care


In an acute episode where finances are of concern, it can be beneficial to offer nursing care in the first instance. This will involve hospitalization in a warm environment, to reduce the energy requirements of the ill bird. The use of incubators or brooders (Fig. 10.1) is recommended in this case, although the use of an airing cupboard in the owner’s home will suffice if hospitalization is not possible.


image

Figure 10.1 Various (a) brooders and (b) incubators are available, providing a convenient way of ensuring ill birds are maintained in a warm environment.

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Sep 3, 2016 | Posted by in SMALL ANIMAL | Comments Off on Regurgitation in a cockatoo

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