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The time required for the liquid to become solid and bond tissues depends on the amount of Evaluation of Suture Materials in Birds water (more water present will delay curing) and the The tissue reaction to five suture materials (poly- thickness of the acrylic applied (thicker will delay glactin 910 buy cheap skelaxin on-line spasms under eye, polydioxanone suture order 400mg skelaxin free shipping yellow muscle relaxant 563, monofilament ny- curing) generic skelaxin 400 mg without prescription gas spasms. Medical grade adhesivess are biologically in- lon, medium chromic catgut and monofilament stain- ert and cause minimal tissue reaction. Some prefer less steel) in pigeons was evaluated at 3, 7, 15, 30, 60, to use the less expensive commercial grade of glue 90 and 120 days following implantation in the body (eg, SuperGlue); however, these contain substances wall. The pigeons in this study developed a marked granulocytic inflammatory re- These materials hold tissues in approximation to sponse the the catgut that diminished during the allow healing to progress; however, cells cannot pene- period of evaluation; however, the material was still trate the adhesive. It is important not to allow the present at the end of the study indicating prolonged adhesive to run between the tissues to be apposed as absorption of the material. Polyglactin 910 is consid- the presence of the acrylic will delay healing by ered nonreactive in mammals. In some cases, especially process of hydrolysis and does not require enzyme with water birds, the acrylic may be applied in a thin degradation. In this study, polyglactin 910 caused the layer over the apposed incision to create a seal yet most intense inflammatory reaction but it was ab- allow epithelial cells to migrate under the acrylic sorbed the most quickly (completely gone by day 60). It is the limbs or digits of tiny patients to splints for considered nonreactive in mammals and is usually orthopedic problems and various other purposes. Caution should be exercised when using these mate- This material behaved similarly in the pigeons stud- rials in the presence of anesthetic gases with which ied. It caused minimal tissue reaction and absorption they are synergistic and may cause ocular irritation and vomiting in avian patients. Analgesics Postoperative Care Historically, it has been considered that birds have a remarkable capacity to deal with pain, although the assessment of what animals perceive as pain is diffi- cult. Research in the area of avian pain perception The patient should be placed in an incubator at 85°F has been minimal. Companion birds have a well with supplemental oxygen during recovery from sur- developed sense of touch and react by loud vocaliza- gery. It is best to continue maintaining the postsur- tion and withdrawal when potentially painful stim- gical patient in a small, controlled environment dur- uli are applied. Clients expect that analgesia will be ing the convalescent period (see Chapter 39). The provided for their pet, and it is the responsibility of patient’s activity level should be kept to a minimum the entire staff to relieve a patient’s postoperative to allow proper tissue healing. Food and water should be placed budgerigars3 to evaluate the effect of high doses of where they are easily accessed by the patient. Toys butorphanol tartratet and flunixin meglumine onu and extraneous objects within the enclosure should heart rate, motor control and respiratory rate. Postoperative antibiotic therapy should be instituted Butorphanol is an opioid analgesic with both agonist when there is a specific indication, such as with open, and antagonist properties, resulting in a “ceiling effect” contaminated wounds or where there has been in- such that above a maximum effective dose, neither traoperative contamination of the surgical field. The action perioperative antibiotic therapy is recommended for and potency of opiates and opioids is related to the specific receptor sites to which a given agent binds. In general, avian patients do not traumatize their There are three major types of opiate receptors. Mu surgical incisions, and they poorly tolerate bandages receptors mediate analgesia and euphoria. Elizabethan collars or neck braces also responsible for physical dependency, sedation should be reserved for the most desperate cases. Kappa receptors also Elizabethan collar is considered necessary, the pa- are involved in analgesia and, to a lesser degree, with tient’s neck should first be wrapped so the collar will sedation and respiratory depression. Using this stimulation results in cardiac and respiratory stimu- technique, a smaller, looser collar may be utilized. In some patients, the center core of cardboard from a Butorphanol exerts its effects at mu and kappa re- roll of bathroom tissue may be padded and used as a ceptors. Doses of 3 to 4 mg/kg of butorphanol given to neck brace alone or in conjunction with an Elizabe- budgerigars had no statistically significant effect on than collar. The first day, the Elizabethan collar 3 heart rate or respiratory rate; however, some treated should open rostrally in the traditional manner. This effect was considered will allow the patient time to become accustomed to minor and all birds remained alert. Return to normal the collar, and it will not damage the wings while the motor coordination occurred within two to four hours patient is struggling to escape the device. No gastrointestinal effects were day, the collar should be reversed such that the cone observed with this agent. Food and water should be placed on a pedestal to ten times this dose are safe in birds. The patient’s weight should be closely monitored to assure that an adequate amount of food Buprenorphine hydrochloridev is another opioid with and water is being consumed. The collar should be agonist/antagonist activity that appears to be effec- tive in controlling pain in avian patients. Vet Surg 18:269- Tissue reaction to five suture materi- Assoc 189:1017-1019, 1986. Board certified surgeons are becoming attracted to the field for the purpose of developing 41 and refining avian procedures. Procedures that were once considered impossible are now performed on a routine basis. The most substantial limitation to soft tissue surgery of the abdomen is the small size (<100 grams) of many avian patients. Surgery of the thoracic area, even in large companion birds, pre- sents a similar problem, in that the organs of interest are covered by the sternum and heavy musculature. Continued improvements in the endoscopic surgical equipment available in human medicine will un- doubtedly improve the surgeon’s ability to perform R. Harrison The avian surgeon should practice surgical tech- niques on cadavers prior to performing the proce- dures on clinical patients. The delicate avian tissues tear in the presence of slight autolysis; therefore, the use of fresh specimens will give the surgeon an ap- preciation of avian tissue characteristics and allow the surgeon to explore the capabilities of surgical instrumentation. When necropsies are necessary, the clinician should approach this procedure from the perspective of a surgeon rather than of a pathologist, by dissecting and reviewing anatomy from a regional approach rather than by performing the necropsy strictly from the traditional ventrodorsal approach. Surgery of the Skin In small birds (eg, Passeriformes), constricting fibers may be visualized using the operating microscope (see Figure 43. A bent 25 ga needle is helpful for The skin and subcutaneous tissues of birds differ removing constricting fibers. Birds have relatively thin, elevate the fiber, which can then be cut by gently dry epidermis, and the dermis is attached to the rolling the needle such that the beveled edge severs underlying muscle fascia with little subcutaneous the fiber. Compared to mammals, the skin exposed tendons may heal without incident once the is only loosely attached to underlying structures, fibers are removed. A hydroactive dressing should be except in the distal extremities where it is firmly placed on any wounds created by the fibers to prevent adherent to underlying bone. Neonates (especially macaws and Eclectus Parrots) Passerine Leg Scales may develop constrictive toe lesions that can result in avascular necrosis of the digit (see Color 30). Pro- Passerine leg scale syndrome is characterized by the posed etiologies for these include low humidity, egg- development of abnormally large scales of the legs 25 related strictures or ergot-like intoxication.
If the bird is represented as captive-bred these cases it is prudent not to add new birds to a but is not closed banded order skelaxin 400 mg on-line spasms all over body, it is useful to know why purchase 400mg skelaxin with mastercard muscle relaxer x. Ideally purchase discount skelaxin line muscle relaxant chlorzoxazone, birds in quarantine should be housed Determining the genealogical history of the bird, separately from the remainder of the collection for a determining if any previous health problems have minimum of sixty days. Birds in quarantine should occurred and evaluating as much information as pos- be attended by an individual who has no contact with sible about the flock of origin can guide the avicultur- the established collection, who takes care of estab- ist in making a wise choice in adding birds. A copy of lished birds prior to servicing the quarantine facility all medical and reproductive records should be re- or who showers and changes clothes after servicing quested. Know- aviary property (eg, a neighbor’s home) is a practical ing when and how the gender was determined in a means of providing an effective quarantine period. Male cockatoos are frequently available for sale Birds placed in separate rooms within a home pro- after they have killed their mate. If a seller isunwill- vide a minimum amount of separation between new ing to freely provide any requested information, the and established residents. Birds that are maintained buyer should be concerned about the validity of any in any enclosure (home or building) with the same air claims that are made concerning a pair of birds. The bowls and all handling equipment used for birds Evaluating a Prospective Purchase in quarantine should not come in contact with the The addition of new birds to an established aviary remainder of the birds in a collection. Additionally, new birds that are misrepre- New Bird Examination sented (inaccurately sexed or sold, due to previous Birds should be examined at the beginning of quar- reproductive failure) represent a loss to the avicul- antine to establish any pre-existing problems and turist by occupying space and requiring care that again at the end of quarantine to detect any clinical could be used for productive pairs. The bird’s quarantine is only a “safety valve” in the prevention gender and the visual health of the reproductive tract of infectious disease and does not ensure that a new should be confirmed by laparoscopy. Diagnostic test- bird is not an asymptomatic carrier of parasitic, bac- ing should be based on the client’s needs, species of terial or viral pathogens. The new bird exam and quarantine testing program should be tailored to the needs and resources of the Quarantine aviculturist and the species of bird. Suggested screening techniques would include a thorough A routine quarantine program for new birds is vital physical examination, Gram’s stain of feces and to protect an established avicultural collection from evaluation of a blood smear. The type of blood chemistry profile and cultures are useful to examinations performed, length of the quarantine detect birds that require more extensive evaluation. In essence, this testing allows the veterinarian to establish a “point- in-time” medical fingerprint for the individual bird. Direct and flotation examination of feces for internal para- sites should also be considered in birds that were recently imported or that are in flights with access to the ground (see Chapter 36). Any thin birds, espe- cially species susceptible to neuropathic gastric dila- tation (formerly proventricular dilatation syndrome) should be examined radiographically. Alternatively, a bird that was captive produced in another country and imported into the United Identification States could have a closed band and an open import band. Such Each new bird should be permanently identified dur- was the case in this macaw. Implantable transponders provide the least alterable identifica- Open bands are the least desirable but are none the tion with minimal risk to the bird. An alternative to removal of these bands is to fitting closed bands are an indication (not proof) that close them as tightly as possible, thereby reducing a bird was bred in captivity. Metal bands must be nately, the numbers often wear off closed bands and removed from the legs of birds exposed to sub-freez- large birds may collapse them, resulting in leg or foot ing temperatures, as they contribute to frostbite. In addition, bands can catch on loose enclo- importance of individual identification was graphi- sure wires. These disadvantages should not dissuade cally demonstrated in the aftermath of Hurricane the serious aviculturist from closed banding nor Andrew’s assault on South Florida in August 1992. The veterinarian can help the aviculturist establish a record system that is best for a particular facility, assist in developing and implementing effective iden- tification systems and evaluate production records. Records that include all available medical informa- tion should be established at the time the bird enters the aviary. Trends indicate an increasing interest in the estab- lishment of stud books and cooperative breeding pro- grams involving private aviculturists. Infected groups can then be Acclimation screened on an individual basis and treated as Birds should be acclimated to their new surround- needed. Birds may refuse food for several days (small birds) or up to a week (larger Annual prophylactic treatment for chlamydiosis is species), especially if the bird was a previous pet. Gavage feeding should outdoors and exposed to free-ranging birds, espe- be used only if the weight loss is dramatic (15% of cially pigeons. In most cases, the indiscriminate use initial weight) in order to avoid unnecessary stress. Exposing birds in bird that is reluctant to eat can be maintained on the a flock to unnecessary or sub-therapeutic levels of diet to which it is accustomed and slowly changed to antibiotics will create “super” strains of bacteria that the diet used by the aviculturist. If quality of water may cause temporary intestinal up- birds are medicated, treatment should be delayed set. A species that will be housed outdoors must be until the non-breeding season (the fall for most spe- slowly acclimated to its new climatic conditions. Egg production will typically decrease during Tropical birds can tolerate northern temperate cli- treatment, and chicks that hatch from eggs laid dur- mates if acclimated for several months before being ing treatment may have developmental abnormalities. Exposure to direct Commercially available oil emulsion adjuvant vac- sunlight can cause burns on the unfeathered portions cines for Pacheco’s virus disease, pox and salmonella of the face. These vac- exposed skin in feather-plucked birds will eventually cines were developed for use in wild-caught imported “tan” and show color changes indicative of melaniza- birds to prevent catastrophic disease outbreaks. Housing of affected birds indoors until the sever- ity of such reactions subsides may be helpful. The Feeding Aviary Birds possibility of birds becoming sensitized (allergic) to Proper nutrition is vital to avicultural success. The goals in formulating diets for Preventive Husbandry Practices captive breeding birds include meeting the known or perceived nutritional requirements, maintaining The level of husbandry advice provided by the veteri- good food hygiene, providing psychological enrich- narian must be adjusted to compensate for the expe- ment by offering variety, and having a diet that is rience of the aviculturist. Successful aviculturists easy to prepare and minimizes labor, waste and ex- frequently have vast experience in animal husbandry pense. In general, breeding birds should receive a and carefully evaluate the behavior and condition of formulated diet, a variety of fresh fruits and vegeta- their birds on a daily basis. In-the-shell peanuts intuitively when problems are occurring that require should be avoided because of their potential for ex- veterinary assistance to identify, correct and prevent. Establishing a species in If a veterinarian expects client compliance, recom- captivity requires an understanding of the feeding mended therapeutic programs must be designed to habits of free-ranging conspecifics. Knowing what address the daily problems faced by the breeder and free-ranging birds consume will define dietary pref- require minimum input of time, labor and resources. In captivity, birds are usually offered the same diet A routine preventive medicine program should be year-round. In contrast, free-ranging Psittaciformes designed around a detailed health history for the must forage for food.
Neck: tonsils enlarged; left ear erythematous generic skelaxin 400 mg mastercard muscle relaxant with alcohol, dried blood in external ear canal bilaterally d buy generic skelaxin 400mg muscle relaxant drug class. Abdomen: no distension buy generic skelaxin 400 mg on line muscle relaxant tv 4096, positive epigastric tenderness, decreased bowel sounds, no rebound or guarding g. Skin: palpable petechiae on bilateral elbows; petechiae on lower extremity and buttocks m. Pediatric surgery consult – no intussusception or other surgical pathology; con- tinue medical management b. Critical actions == Fluid resuscitation == Abdominal x-ray == Pain management == Laboratory evaluation of liver and renal injury == Surgery consult L. The cause is unknown, but often follows an upper respiratory infection and is immunologically mediated. When prompted, the mother will describe a rash on the lower extremity and buttocks for a few days. The rash often begins as pink maculopapules that blanch on pressure and pro-The rash often begins as pink maculopapules that blanch on pressure and pro- gresses to petechiae or purpura. It is often palpable (and henceforth the pathogno- monic fndings of “palpable purpura”). The lesions favor the lower extremities and occur in crops lasting from 1 week to 10 days. An abdominal radiograph or ultrasound may aid in the diagnosis of intussuception, but the gold standard is a barium enema test. However, imaging and labs should be ordered on the basis of the clinical picture, and to evaluate other abdominal pain causes (such as intussusception). Admission to the hospital may be appropriate if the diagnosis is in doubt, in chil- dren with severe symptoms, or concern for renal and abdominal symptoms. The pet snake escaped from a tank and is green and brown with black spots (must ask). Full range of motion, motor and sensory intact, no erythema, no edema, no induration; otherwise unremarkable examination h. The most important intervention is to assess the patient’s respiratory and cardiovascular status. The candidate should determine if airway management or cardiovascular resuscitation with fuids or pressors is needed. If possible, collect the snake in ques- tion (local animal control authorities may be contacted). Meanwhile, assess bite marks of local progression and expose the patient to visualize any other possi- ble bites. Luckily for the child in this case, the snake was of the nonpoisonous variety and prompt identifcation of the snake allowed for minimal invasive intervention and early discharge. Antivenin is specifc for each group of snakes; the local Poison Control Center may be helpful in determining the need. The majority of snakes are nonpoi- sonous but two major groups do pose a threat: crotalids (pit vipers including rattlesnakes, cotton mouths) and elapids (coral snakes, cobras). Crotalid venom is predominantly cytolytic and may cause edema, hemorrhage, and necrosis close to and far away from the bite. Systemic signs and symptoms may include hemolysis, thrombocytopenia, disseminated intravascular coagul- opathy, vomiting, and cardiovascular and respiratory failure. Elapids tend to have neurotoxic venom producing neurological symptoms (dip-Elapids tend to have neurotoxic venom producing neurological symptoms (dip- lopia, ptosis, respiratory depression, parasthesia). Note that frst-aid treatments such as suction and incision along with tourni- quets are contraindicated. Constriction band with an elastic bandage or penrose drain, rope, or clothing wrapped proximal to the bite may retard venom absorp- tion without compromising arterial fow. No fever, chills, nausea, vomiting, chest pain, shortness of breath, trauma, numbness, tingling, and weakness noted. Fundoscopic examination demon- strates intraretinal blood and macular edema, intraocular pressures normal c. Neuro: alert and oriented, no focal motor, sensory defcits; no neglect with left eye; no facial asymmetry; normal memory; gait normal i. Examination demonstrates unremarkable sclera, conjunctiva, and anterior chamber in both eyes. This is a case of central retinal vein occlusion or blockage of blood fow to the eye. If neurology consultation is attempted, the consultant will defer to the ophthalmologist’s recommenda- tions. Patients should be referred to oph- thalmologist within 24 hours for assessment of possible glaucoma or other pathologies. Optic disc edema and diffuse retinal hemorrhages in all quadrants are patho-Optic disc edema and diffuse retinal hemorrhages in all quadrants are patho- gnomonic for central retinal vein occlusion. Ophthalmoscopic examination reveals dilated and tortuous veins, retinal and macular edema, diffuse retinal hemorrhages and attenuated arterioles. An affer- ent pupillary defect may be noted in the affected eye – loss of vision in that eye prevents light information from being relayed to the brain. Thus, light shone Case 16: Visual impairment Case 17: syncope 89 in the affected eye will not be perceived, and the pupils dilate. When light is directed into the unaffected eye, the information is transmitted to the brain normally, and both pupils receive a signal to constrict. Optic neuritis, though often presenting with similar symptoms as retinal vein occlusion, can be excluded as it is devoid of peripheral hemorrhage on examination. During exercise she developed palpitations and shortness of breath followed by fainting. Social: lives with parents at home, denies alcohol use, smoking, drugs, or sex- ual activity f. Patient remains in ventricular fbrillation/torsades until two shocks and magnesium are administered. Once torsades occurs as in this patient, magnesium sulfate is the drug of choice for conversion, but unstable patients need defbrillation. Postarrest care includes an antiarrhythmic like lidocaine as with any severe arrhythmia. Comfortable appearing male, slightly drooling and sitting upright, holding head and neck still. Circulation: moves all extremities, skin color within normal limits 94 Case 18: sore Throat E. No fever, no cough, no photophobia, no nausea, no vomiting, no abdominal pain noted and no prior episodes noted in him. General: alert, oriented × 3, sitting upright in stretcher, holding head and neck in a fxed position, slightly drooling b. Neck: no stridor, no anterior cervical lymphadenopathy, pain with extension of neck g. Surgery – otolaryngology – assessment shows swelling in soft tissue around the posterior pharynx, normal vocal cords without edema, patent airway. This is a case of retropharyngeal abscess, a serious infection of the soft tis- sue behind the pharynx, which can in severe circumstances lead to a clos- ing of the airway and inability to breath.