Evaluation of an endoscopic liver biopsy technique in green iguanas

Evaluation of a ventral and a left lateral approach to coelioscopy in bearded dragons (Pogona vitticeps)

OBJECTIVE

To compare a ventral and a left lateral endoscopic approach to coelioscopy in bearded dragons (Pogona vitticeps).

ANIMALS

18 adult bearded dragons.

PROCEDURES

In a randomized crossover design involving 2 surgical approaches, anesthetized bearded dragons first underwent coelioscopy with a ventral approach (left lateral of midline next to the umbilicus; animal positioned in dorsal recumbency) or left lateral approach (intercostal; animal positioned in right lateral recumbency) and then with the alternate approach. A 2.7-mm × 18-cm, 30° oblique telescope with a 4.8-mm operating sheath and CO₂ insufflation at 2 to 5 mm Hg were used. Ease of entry into the coelom and ease of visual examination of visceral structures were scored.

RESULTS

Both approaches were straightforward, with the left lateral approach requiring significantly more time than the ventral approach. Scores for ease of visual examination for the heart, lungs, liver, stomach, intestines, pancreas, gallbladder, left kidney, gonads, and fat body were good to excellent. Visual examination of the spleen and adrenal glands was difficult in most animals via either approach. The left kidney, testis, and vas deferens were easier to see with the left lateral approach, whereas the pancreas in females and gallbladder in both sexes were easier to see with the ventral approach. All bearded dragons recovered without complications from the procedures, except for one with nephritis, renal gout, and hepatic necrosis.

CONCLUSIONS AND CLINICAL RELEVANCE

Both coelioscopy approaches could be safely and effectively used in bearded dragons. Choice of approach should be based on the coelomic structures requiring evaluation.

Diagnostic value of plasma biochemistry, haematology, radiography and endoscopic visualisation for hepatic disease in psittacine birds

BACKGROUND

Hepatic disease in psittacine birds is common but challenging to diagnose. This retrospective study evaluates the diagnostic value of plasma biochemistry, haematology, radiography and endoscopic visualisation in psittaciforms with suspected hepatic disease that underwent endoscopic liver biopsy.

METHODS

Clinical records of 28 companion psittaciforms from a veterinary teaching hospital (2007-2016) were reviewed. Diagnostic results were categorised as abnormal or normal and compared with histopathology for agreement or disagreement. Statistical significance was determined by kappa test for agreement and McNemar's test for disagreement.

RESULTS

11 of 28 psittaciforms (39.3 per cent) had clinical signs considered specific for liver disease. 25 of 28 (89.3 per cent) psittaciforms had histopathological liver lesions. Gross changes radiographically and endoscopically agreed with histopathology in 57.1 per cent and 53.6 per cent of cases, respectively. Aspartate aminotransferase (AST) (48.1 per cent), creatine phosphokinase (73.1 per cent) and albumin by protein electrophoresis (50 per cent) showed the highest agreement. Kappa was not significant for any parameters, while McNemar's test for disagreement was significant for radiography, endoscopy, AST, lactate dehydrogenase, bile acid, total protein (chemistry), cholesterol, triglycerides, uric acid and glucose.

CONCLUSION

Overall, changes on plasma biochemistry, radiography or endoscopy are non-specific and do not consistently agree with histopathology results. Endoscopic liver biopsy is highly recommended if there is clinical suspicion of hepatic disease.

Reptile Soft Tissue Surgery

The surgical approach to reptiles can be challenging. Reptiles have unique physiologic, anatomic, and pathologic differences. This may result in frustrating surgical experiences. However, recent investigations provided novel, less invasive, surgical techniques. The purpose of this review was to describe the technical aspects behind soft tissue surgical techniques that have been used in reptiles, so as to provide a general guideline for veterinarians working with reptiles.

Making the Difference in Exotic Animal Practice: The Value of Endoscopy

The definitive diagnosis has often been elusive in exotic pet medicine, and its absence has been, and continues to be, the source of much client anguish and practitioner frustration. To reach a definitive diagnosis, demonstration of a pathologic response and the etiologic agent are required. This article demonstrates why such an approach is necessary and how it can be readily achieved in practice using endoscopy.

Evaluation of liver parenchyma and perfusion using dynamic contrast-enhanced computed tomography and contrast-enhanced ultrasonography in captive green iguanas (Iguana iguana) under general anesthesia

Background

Contrast-enhanced diagnostic imaging techniques are considered useful in veterinary and human medicine to evaluate liver perfusion and focal hepatic lesions. Although hepatic diseases are a common occurrence in reptile medicine, there is no reference to the use of contrast-enhanced ultrasound (CEUS) and contrast-enhanced computed tomography (CECT) to evaluate the liver in lizards. Therefore, the aim of this study was to evaluate the pattern of change in echogenicity and attenuation of the liver in green iguanas (Iguana iguana) after administration of specific contrast media.

Results

An increase in liver echogenicity and density was evident during CEUS and CECT, respectively. In CEUS, the mean ± SD (median; range) peak enhancement was 19.9% ± 7.5 (18.3; 11.7-34.6). Time to peak enhancement was 134.0 ± 125.1 (68.4; 59.6-364.5) seconds. During CECT, first visualization of the contrast medium was at 3.6 ± 0.5 (4; 3-4) seconds in the aorta, 10.7 ± 2.2 (10.5; 7-14) seconds in the hepatic arteries, and 15 ± 4.5 (14.5; 10-24) seconds in the liver parenchyma. Time to peak was 14.1 ± 3.4 (13; 11-21) and 31 ± 9.6 (29; 23-45) seconds in the aorta and the liver parenchyma, respectively.

Conclusion

CEUS and dynamic CECT are practical means to determine liver hemodynamics in green iguanas. Distribution of contrast medium in iguana differed from mammals. Specific reference ranges of hepatic perfusion for diagnostic evaluation of the liver in iguanas are necessary since the use of mammalian references may lead the clinician to formulate incorrect diagnostic suspicions.

Evaluation of diagnostic coelioscopy including liver and kidney biopsy in freshwater turtles (Trachemys scripta)

The objective of this study was to establish a safe and effective endoscopic technique for the examination of coelomic viscera and for the collection of liver and kidney biopsy specimens from turtles by use of a 2.7-mm rigid endoscopy system that is commonly available in zoologic veterinary practice. Twenty-two adult freshwater turtles (Trachemys scripta) were anesthetized for both left and right coelioscopic examinations. Ease of entry and organ visualization were scored, and liver and kidney biopsy specimens were collected from each turtle by use of 1.7-mm endoscopic biopsy forceps. Biopsy samples were evaluated histologically for quality and crush artifact. Five days after surgery, all turtles were euthanatized and underwent full necropsy examination. For all 22 turtles, left and right mean entry and visualization scores were satisfactory to excellent for all measured parameters except spleen because the spleen was impossible to locate from the left side. No iatrogenic trauma was evident, and biopsy specimens were consistent with tissues collected at necropsy. Liver biopsies suffered from greater crush artifact, compared with kidney biopsies. By use of a 2.7-mm rigid endoscopy system, coelioscopy, liver and kidney biopsy procedures can be performed safely, swiftly, and with ease in turtles. Biopsy specimens obtained by this technique are suitable for histologic examination. Endoscopy is recommended for the examination and biopsy of coelomic viscera in chelonians.

Reptile diagnostic endoscopy and endosurgery

The 2.7-mm telescope commonly used in avian practice has transitioned into an invaluable diagnostic tool for the reptile clinician. Previously plagued by vague medical histories, nonpathognomonic physical examinations, indistinct diagnostic images, and less than conclusive clinical pathology results, the reptile clinician often has had trouble making a definitive, antemortem diagnosis. A definitive diagnosis generally relies on the demonstration of a host pathologic response and the causative agent. The ability to examine internal structures and collect biopsies has enabled many postmortem diagnoses to now be appreciated in the living animal, and along with accurate diagnosis comes accurate prognosis and improved case management. The advent of 3-mm human pediatric laparoscopy equipment has fueled interest in minimally invasive endosurgery in exotic pets, including reptiles. However, the chelonian shell has also served as a catalyst to speed the development of surgical approaches to the coelom that do not involve major shell surgery. This article summarizes the most common endoscopic approaches in lizards, chelonians, and snakes for the purposes of making a diagnosis and increasingly performing endosurgery.