Regurgitation (Vomiting) in Snakes
Dr. Nancy Anderson
A thorough husbandry history for vomiting or regurgitating snakes will usually include: questions about cage temperature and how it is measured; presence of a temperature gradient; types of heating and light elements; light cycle; presence and type of hide boxes; access to water; size selection of prey item; presence of cage mates; last breeding date; and usual time of feeding.
Diagnostic tests may include:
Your veterinarian will also want to know if your snake has been exposed to other reptiles or their feces. Even the simple act of borrowing a contaminated feeding bowl, cage or hide box from a friend could introduce an infectious organism.
Hematology (analysis of red and white blood cells) will allow your veterinarian to determine if an overwhelming bacterial infection is an underlying cause of vomiting or regurgitation.
Serum chemistries (blood test that evaluates organ function and electrolyte levels) can be used to look for underlying kidney or liver disease. In addition, serum chemistries can be used to diagnose mineral or electrolye imbalances such as hypocalcemia (low blood calcium) or hypokalemia (low blood potassium) that have occurred secondary to the vomiting or regurgitation. In addition to the chemistry values mentioned above, values for glucose (blood sugar), cholesterol, total protein and bicarbonate (helps to regulate the blood pH) can help your veterinarian give you a prognosis for your snake's recovery.
Cytologies, specialized fecal tests and cultures are important to determine the actual cause of any thickening or infection. A specific cause will allow your veterinarian to select the best treatment plan and also give you an estimation of your snake's chances of getting better.
X-rays or ultrasound can be used to determine if your snake is not eating due to an obstruction. Many, but not all snakes will also regurgitate (throw up) if they have an obstruction. Most gastrointestinal obstructions occur in snakes when they ingest bedding or a foreign object (foreign bodies) while they are swallowing a normal food item.
It can be difficult to see foreign bodies made of cloth, plastic and plant materials using plain X-rays. If your veterinarian suspects that your snake has swallowed something made with these materials, he/she may need to tube feed your snake with a special dye (radiographic contrast material) before taking more X-rays. Two common types of dyes that are used are barium and iodine solutions (Iohexol is one trade name).
If your snake needs to have a contrast X-ray study, be prepared to be patient. Because snake intestines digest food slowly, it can take up to a week for the dye to get to the end of the intestinal tract. Luckily, in most cases, a diagnosis can be made in 24 to 48 hours. Keeping the snake at the warm end of its preferred optimum temperature range can help decrease transit times (the time it takes the dye to go from the stomach to the vent).
Gastrointestinal obstructions can also occur if organs, such as the liver or kidney, become enlarged. Common causes for organ enlargement include: neoplasia (cancer); abscesses; retained ovarian follicles; retained eggs; and fluid-filled cysts. If they become large enough to fill up the entire diameter of the snakes body, they will compress (press on) the intestines. Even though the intestines might be normal, food cannot pass the point of compression so the clinical signs will be the same as for an intestinal foreign body. The walls of the intestines or stomach can also become thickened as a result of Cryptosporidia, neoplasia, abscesses, stricture, edema (fluid accumulation) or inflammation. If the walls become too thick, they will block passage of food as well. X-rays and ultrasound are used to differentiate between foreign bodies (intraluminal obstruction), compression (extraluminal obstruction) and thickening of the intestinal wall (intramural obstruction).
Treatment may include:
If your snake has a medical cause for throwing up and after it has been on medications and fluids for a few days, your veterinarian may elect to tube feed it with a combination of meat baby food, veterinary supplements or ground prey items designed to gear your snakes stomach and intestines to receive normal food again.
Once your snake is not throwing up and producing normal stools with this combination, it is time to offer small prey items. Once the snake has formed normal stools, you can start to slowly increase the prey size back up to normal size. It is extremely important to contact your veterinarian if your snake starts to throw up at any time during treatment. It is an indication that the reintroduction to solid foods is occurring too quickly or that there is an untreated underlying problem.
Although a few drugs can be used to slow the progression of Cryptosporidia, it is usually not a treatable disease. Since the sick snakes acts as a source of the parasite for uninfected snakes, it is often necessary to euthanize (humanely kill) or permanently quarantine affected snakes. Humans are not known to be susceptible to the snake form of Cryptosporidia.
If your snake has an obstruction, due to a foreign body, there is a good chance that your veterinarian will need to either perform surgery or endoscopy to remove the blockage. If the obstruction has not been present so long as to interfere with blood circulation to the wall of the intestines, snakes usually tolerate surgeries to remove foreign bodies extremely well.
In some cases where snake have swallowed lots of small pieces of bedding (such as gravel), oral fluids and lubricants administers along with lubricating enemas can sometimes relieve the impaction. These procedures must be performed very carefully in order to avoid worsening the obstruction, causing aspiration pneumonia or rupturing the gastrointestinal tract.
If your snake has an obstruction, due to compression or a thickening of the intestinal wall, your veterinarian will need to ascertain the specific cause of the swelling. If the cause is diffuse and sue to an infectious agent, your veterinarian will likely treat your snake with systemic drugs. If the thickening is localized, your veterinarian may need to perform surgery in addition to administering systemic medications.