Regurgitation (Vomiting) in Snakes

Snakes, like all other animals, do get sick. Regurgitation is the casting up of undigested food and is most frequently associated with husbandry. Regurgitation must be differentiated from vomiting, which is the forceful ejection of the contents of the stomach and small intestine. True vomiting is always a sign of significant disease that requires medical treatment by your veterinarian.

Regurgitation is the more common form and is the only form associated with husbandry problems. Regurgitation is more passive and occurs soon after a snake has attempted to or has swallowed a meal. Therefore, the food item has not had time to be thoroughly digested and can be recognized as a prey animal. In regurgitation, mild waves of contraction move backwards up the body of the snake.

Vomiting usually occurs after the snake has partially digested its meal. Many times since the snake is bringing up intestinal contents from further back in the gastrointestinal tract, the snake seems to be more distressed by vomiting. The material produced by vomiting often looks like a stool with no urates (white chalky material seen with feces).

The most common diseases associated with throwing up are: intestinal parasite infections (amoebiasis, cryptosporidiosis, nematodes), bacterial infections and intestinal obstructions. Vomiting is less commonly associated with liver failure, kidney failure, cancer and viral infections.

Husbandry Problems

The most common husbandry problems associated with regurgitation are

• Excessive handling. To avoid regurgitation, snakes should not be handled for 48 hours after a meal. After any kind of transport, your snake should not be fed for at least seven days to allow rest and reorientation. Water should also be provided during this time. Excessive handling can also injure the distended intestines.
• Cage temperature. In regurgitation problems the temperature is usually too low to allow prompt digestion of a prey item.
• Overfeeding. Most species should be fed every 1-2 weeks, and some larger snakes can go up to 4 weeks between feedings. Prey size should be proportional to snake size and should not be larger in diameter than the snake’s head.
• Lack of a quiet hide place in which the snake can rest and digest its meal.
• Stress due to excessive handling. After eating , snakes should not be handled for at least 24 hours . Handling them at such a time cannot only cause vomiting. Extreme temperatures may also cause vomiting
• If vomiting occurs , allow the snake to rest several days before trying to feed it again. If using pre-killed food, make it is warm to the touch and fresh . Finally, give the animal plenty of privacy and time.
• If your snake is throwing up, it is not getting the proper amount of nutrients from its food. As a result, if your snake continues to vomit, it will starve to death. The chances for recovery are much higher for vomiting or regurgitating snakes if they are treated prior to losing a significant amount of body weight.

Diagnosis

Diagnostic tests may include:

• History. Unless your veterinarian finds an obvious cause for throwing up on physical examination, a detailed history will be extremely important. Questions will most likely focus on: cage temperatures; hide boxes; prey size; timing of handling the snake after feeding; exposure to other snakes; and timing of last fecal examination.
• Abdominal palpation. An excellent abdominal palpation is an important part of the physical examination.
• Examination of the vomitus. If a snake is vomiting, it can be difficult to distinguish vomitus from feces. If the vomitus is fresh (an hour or two old), your veterinarian can test the pH to determine if the material came through the stomach or the vent (snake’s rectum). If it is vomitus, the pH of the material will be acidic because of stomach acids. If it is feces, it will be basic. After roughly 2 hours, even vomitus will become basic as bacteria digest the material and cause the pH to become more basic. Regurgitation of mucous alone is a grave sign and is often associated with death.
• Fecal examination. Your veterinarian will almost always want to run a fecal examination to look for intestinal parasites. It is common for snakes that are experiencing chronic vomiting to have empty gastrointestinal tracts and so are not producing stools. In this case, your veterinarian may want to perform a colonic wash to obtain an adequate fecal sample. In addition to a routine fecal examination, your veterinarian may wish to submit special cytologies or cultures.
• Stomach wash. If your veterinarian suspects a Cryptosporidia infection or a medical problem located in the stomach, he/she may suggest performing a stomach wash. The fluid retrieved from stomach washes is usually tested for nematode parasites. Additional tests are usually required to diagnose Cryptosporidia or bacterial infections.
• X-rays. If your veterinarian palpates (feels) an abdominal mass, an X-ray or an abdominal ultrasound may be recommended.
• Further tests. If your snake has been throwing up for over one to two months (depending on the size and age of the snake) or has lost significant body condition, further diagnostic tests are warranted. Tests commonly performed on vomiting or regurgitating snakes include: hematology (analysis of red and white blood cells); serum chemistries (evaluates organ function); X-rays; cytologies (microscopic examination of discharges or small samples of tissue); specialized fecal analysis; and bacterial or fungal cultures.

Treatment

Treatments may include:

If your snake appears healthy on physical examination, treatment is aimed at improving husbandry and removing any intestinal parasites that may have been diagnosed on a fecal examination. In addition, your veterinarian may recommend the following:

• Fluid therapy. Most snakes that are vomiting or regurgitating are dehydrated. Your veterinarian will most likely want to administer subcutaneous (under the skin) or intraperitoneal (into the abdominal cavity) fluids. The fluids cannot be administered orally, because the snake will vomit the fluids.
• Fasting. Your veterinarian will probably recommend that your snake fast (not eat) for a few days while the medications are taking effect. After this, he/she may want to tube feed an easily digestible liquid meal before attempting to return your snake back to its regular diet.
• Drug therapy. Treatment of nematode and amoebic infections requires antiparasite drugs (de-wormers) that are prescribed for the specific parasites. Bacterial infections are treated with antibiotics.
• Surgery. If your veterinarian diagnoses an abdominal mass or an intestinal obstruction, surgery or endoscopy might be needed to further diagnose and correct the problem.

Home Care

It is important that you administer fluids, food supplements and medications according to your veterinarian’s instructions. If you notice vomiting or regurgitation, contact your veterinarian immediately, as this is a sign that the medications need to be updated. Schedule regular veterinary visits to monitor the condition.

Observe the general activity level and interest of your pet. Note the character and frequency of stools. Pay attention to his environment:

• Use a thermometer to measure the temperature gradient in the cage. Just feeling cage surfaces to feel if they are hot or cool is not precise enough. Adjust heating devices to maintain a temperature range recommended by your veterinarian.
• Make sure that your snake has a selection of proper hide boxes.
• Do not handle or disturb your snake for at least 48 hours after feeding. Imagine the result if if someone picked you up and sloshed you around after eating a Thanksgiving Day meal.
• Make sure that the size of prey is appropriate for your size snake. A good rule of thumb is that the head of the prey animal should be no larger than ¾ the diameter of the snake’s head. Prey that is too large will often stimulate regurgitation.

Preventative Care

Excellent husbandry will prevent most snakes from throwing up. The best prevention against your snake acquiring a medical problem that results in throwing up is to buy healthy captive bred snakes that have not been exposed to a variety of other snakes.

• Do not feed your snake on substrates (such as pea gravel or wood chips) that can become adhered to the prey item. Do not leave rags or towels in snake’s cages, especially around feeding time.
• Avoid handling snakes for at least 48 hours after a meal.
• Have your veterinarian test a stool sample from your snake for the most common parasites found in that species. Follow your veterinarian’s instructions for administering de-wormers. In addition, make sure you clean and disinfect your snake’s cage and cage furniture after all de-wormer doses. This will minimize your snake’s chances of re-infecting itself from immature parasites or parasite eggs that may be in the cage.

There are two types of throwing up. Regurgitation is the more common form and is the only form associated with husbandry problems. Regurgitation is more passive and occurs soon after a snake has attempted to or has swallowed a meal. Therefore, the food item has not had time to be thoroughly digested and can be recognized as a prey animal.

In regurgitation, mild waves of contraction can be seen moving backwards up the body of the snake. Vomiting usually occurs after the snake has partially digested its meal. Many times since the snake is bringing up intestinal contents from further back in the gastrointestinal tract, the snake seems to be more distressed by vomiting. The material produced by vomiting often looks like a stool with no urates (white chalky material seen with feces).

Causes

• Although many parasite infections that cause vomiting in snakes are caused by nematodes — the classic “worms” that most people think of — there are two parasites that commonly cause vomiting in snakes that are single celled organisms. They are Entamoeba invadens and Cryptosporidium. Both of these parasites require special tests performed on feces or stomach washes for diagnosis.
• Amoebiasis frequently causes diarrhea in addition to vomiting. Classic Cryptosporidia infections are associated with gastric hyperplasia (swelling of the wall of the stomach). Although both organisms can be easily transmitted from snake to snakes through contact with feces, amoebiasis is frequently transmitted between different types of reptiles. Turtles commonly serve as carriers for Entamoeba invadens. Mixing turtles and snakes in the same enclosure if not recommended.
• Vomiting can be associated with viral infections. Inclusion body disease of boids is associated with regurgitation especially in Burmese pythons. There are many other viruses that infrequently cause vomiting in snakes.

Diagnosis In-depth

Diagnostic tests may include:

• 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.
• 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
• 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.

Optimal treatment for snakes with vomiting or regurgitation requires a combination of home and professional veterinary care. Follow-up can be critical and may include one or more of the following:

• Administer any prescribed medications or food supplements as directed by your veterinarian.
• Be certain to alert your veterinarian if you experience any problems while treating your pet. Be especially careful to report regurgitation, decreases in activity or the development of diarrhea.
• If your snake’s cage is located in a high traffic room, consider getting a cage cover because it can give your snake extra seclusion when its time to rest. If your snake still regurgitates, it may be necessary to move it to a quieter location.
• If your snake has cage mates, try feeding and/or housing your snake separately.
• Be sure to clean and disinfect the cages and cage furniture of any snake that is being treated for throwing up. Parasitic, bacterial and viral causes of throwing up are contagious to other reptiles. Some bacteria that can cause throwing up such as Salmonella and Pseudomonas can also infect people and cause serious disease. It is important to avoid contact between reptile cages and cage furniture and food preparation or human bathing areas.