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This chapter describes cases reports submitted by veterinarians worldwide. Case reports Dentistry Back to Top Tusk fracture in 36 months old African elephant Tusk fracture repair in 9 yr-old Asian elephant Tusk fracture repair in 4 yr-old African elephant Tusk (crack) fissure repair in 22 yr-old Asian elephant Tusk sulcus infection in adult Asian elephant T usk sulcus trauma after tusk fracture (2x) Tush loss in female Asian elephant Mandibular fracture Weight loss due to abnormal molar change Supernumerary tusk in an African elephant Impacted Molar Dentition in a 27 yr-old Asian elephant Dermatology Skin wounds in adult Asian elephant Wound treatment after fetotomy Wound treatment after vaginal vestibulotomy Temporal gland impaction: non-surgical treatment Temporal gland impaction: surgical treatment Temporal gland bursitis: surgical treatment Back to Top Reproduction Vaginal vestibulotomy (1996) Vaginal vestibulotomy (2014) Fetotomy Back to Top Ophthalmology Bilateral corneal opacity Back to Top Orthopedic problems Partial pad and nail loss in a 54 yrs-old female Asian elephant Back to Top Infectious diseases Salmonellosis in a group of African elephants Salmonellosis in 7 yr-old Asian elephant Colic and Salmonellosis in an adult Asian elephant Salmonella septicemia in an adult Asian elephant Elephant Endotheliotropic Herpes Virus-Hemorrhagic Disease (EEHV-HD) Fasciolasis in a group of African elephants Rabies in an Asian elephant Back to Top Non-infectious diseases Clostridium botulinum in a herd of elephants Back to Top Clostridium perfringens enterotoxemia in a 6 weeks-old African elephant Intoxication Dieffenbacchia intoxication Paraquat intoxication Back to Top Gastro-intestinal problems Esophagus spasm in an adult Asian elephant Esophagus impaction in a 4.5-yrs-old African elephant Hernia mesenterialis and intestinal rupture in an Asian elephant calf (1 year old) Intestinal impaction caused by Saccharum bengalense in a captive juvenile Asian Elephant: Implications for captive management. Back to Top Hiccup Miscellaneous Hiccup Asian elephant with suspected hypocalcemia Hiccup Asian elephant with polycystic nephritis Perineal hernia Colic and abdominal surgery Allonursing in an African elephant Back to Top

This page describes eye problems in elephants and how to treat them. Blepharitis, conjunctivitis, cornea edema, keratitis, vitamin A deficiency, corneal ulcer, cataract, hypopion, uveitis, synechia, iris prolaps, and panopthalmitis. Ophthalmology Compiled by Dr. Khyne U Mar, DVM and Willem Schaftenaar, DVM Eye problems are common in elephants. They are often the result of trauma and present as superficial or deep cornea lesions and ulcers. Cataracts are also regularly seen in elephants. If the vision in one eye is reduced, the animal should be approached with care from that side. In a study in 1478 captive elephants (2956 eyes) in Thailand, 17.83% of the examined eyes from 369 elephants (24.97% of the total number of elephants) had anterior ocular abnormalities. The most common lesions in these examined eyes were frothy ocular discharge (5.85%), corneal edema (5.31%), and conjunctivitis (5.18%). In addition, epiphora, phthisis bulbi, other corneal abnormalities, anterior uveitis, and lens abnormalities were noted. Almost all lesions increased in frequency with age (Kraiwong, 2015). Regular ophthalmic examination in elephants should be included in their annual health check program. Early detection and treatment of any ocular abnormality may avoid the development of subsequent irreversible ocular pathology. Clinical examination overview and diagnostic techniques The clinical examination of the eye starts with the anamnesis (history) and observation of the animal. The eyelashes should be long in order to protect dirt and objects from touching the surface of the eye. They are located mostly superior to the eye and can be as long as 11 cm. The inferior eyelid has less and smaller (2 cm) lashes. A unique feature of the elephant eye is the lack of a lacrimal apparatus (lacrimal glands as well as nasolacrimal duct) and eye brows. Tear films simply flow towards the medial canthus and exit along a groove in the skin onto the face in Asian elephants (Wong et al. 2012). The area around the eyes is therefore often wet. A Schirmer tear test can be performed in elephants. In a research cohort of 80 healthy Asian elephants the mean value was 34.3+/- 1.7 mm/min with older elephants (>40 years) having higher values than younger ones (<20 years). The cornea should be clear, without any irregularities. The iris of an elephant varies in color from tan, yellow, brown or the combinations. Blepharospasm is a strong indication for ocular disease. Conjunctiva cultures can be taken, though the strong palpebrae can make sampling for culture a challenge. Ophthalmic anesthetics can be used safely in elephants and may facilitate clinical examination and allow ophthalmoscopic examination of the deeper ocular structures. The pupillary light response can be performed if the elephant trusts the clinician enough to approach the animal with a proper light source at the required short distance. This test should be performed in subdued light. The menace response can be performed if the animal allows the clinician at short distance by moving fingers towards the elephant's eye without causing air movement. The numerous hairs on the skin of the palpebrae are not true cilia or true eyelashes as they are not associated with the margins of the palpebrae (Wong et al 2012, J. Zoo and Wildlife Med., 43(4), pp 793-801). The lower eyelid is more developed and ascends to a greater degree than the upper lid descends (Suedmeyer, 2006). (Photo KUMar) The iris of an elephant can have several colors: tan, yellow, brown or a combination. (Photo: W.Schaftenaar) A white, circumferential ring, similar to the arcus senilis in man is noticed in 40+ yr Asian elephant (fat deposit or aging?). (Photo: KUMar) Fluorescein staining of the cornea may be difficult as the elephant will close its eye immediately when approached. A fluorescein strip can be placed in a 10 ml syringe with sterile water or saline; this solution can then be sprayed over the eye in a constant flow using a blunt small gauge needle. This should be sprayed on the eye from the medial or lateral side. It helps when at the same time a steady water stream is directed at the periocular skin, which may result in relaxation of the animal. After fluorescein has been sprayed on the cornea, the eye should be flushed with sterile saline to remove excessive fluorescin. If present, cornea defects will stain green under blacklight and even under regular light. Cataracts which appear as a white central spot and keratitis (diffuse, superficial cloudiness of cornea) are frequently seen in elephants. Vision can be checked by passing the light of a flashlight (or cell phone) from the ear over the eye to observe for a blinking reflex. Ophthalmoscopy in the untrained elephant can be quite a challenge, as the animal will usually not allow this kind of close examination that moreover uses a light source. However, the animal can be trained to allow ophthalmoscopy. The third eyelid or nictitating membrane is located at the ventro-medial aspect of the orbit. Inside the nictitating membrane, an oblong, flanged-shaped piece of hyaline cartilage supports the anterior palpebral aspect of the nictitating membrane. The harderian gland that is located here, plays a role in the lubrication of the cornea. Zeis's glands (modified sebaceous glands) are located in the margins of the lid. They produce an oily substance that helps lubricate the cornea. Blinking reflex The nictitating membrane in an Asian elephant (arrow).(Photo: KUMar) Blinking reflex using a smartphone's flash light in an Asian elephant with chronic keratitis. (Video: W.Schaftenaar) Ultrasonographic examination The clinical examination of the elephant's eye can benefit from transcutaneous ultrasonographic examination. The anterior eye chamber, the lens end the posterior eye chamber can be visualized using a 4-7 MHz convex probe (Bapodra et al. 2010). Following are descriptions of the anatomical components of the eye and the medical condition that may occur Eyelids Blepharitis is an inflammation of the eyelids than can be caused by trauma (rubbing), parasite infection or as part of a localized dermatitis. The accompanying symptoms are blepharospasm, epiphora (tearing that appears as wet skin area below the eye) and often photophobia. Sometimes lice (Haematomyzus elephantis ) or ticks (Amblyomma tholloni) can be found on the eyelids causing local skin lesions. Blepharitis in an Asian elephant. (Photo: KUMar) Small skin lesion caused by ticks (Amblyomma tholloni) (Photo: KUMar) Conjunctiva The conjunctiva is the tissue that lines the inside of the eyelids and covers the sclera (the white part of the eye ). It is composed of unkeratinized, stratified squamous epithelium with goblet cells , and stratified columnar epithelium . The conjunctiva is highly vascularized, with many microvessels . Conjunctivitis is an inflammation of the conjunctiva and is a common finding in elephants. In some cases small nodules and vesicles may be observed (lymphoid tissue on histology), possibly associated with chronic irritation. A conjunctivitis is often the result of trauma (hard object, dust, irritating liquid or smoke). Conjunctivitis is also seen in poxvirus infections. Conjunctivitis in an Asian elephant (From: Elephant care manual for mahouts and camp managers, FAO 2005 , Conjuctivitis and keratitis in an Asian elephant. Note the swollen mucosa. (Photo: KUMar) The conjunctival sac is a connection between the palpebral and bulbar conjunctiva. Under certain conditions (hypoproteinemia, trauma, insect bites or allergic reactions), a prolapse of this part of the cornea can develop, which protrudes like a mucosal sac between the eye and the lower eyelid. Prolapse of the conjuncitival sac in an Asian elephant. (Photo: KUMar) Cornea The cornea is transparent because it lacks cells and blood vessels and has no pigment. The cornea should always be wet thanks to a pre-corneal film tear. Oxygen and nutrients are available from the aqueous cornea tear film, the limbal capillary plexus and the palpebral conjunctival capillaries. Several disorders of the elephant cornea have been reported. Most of the corneal lesions seem to have a traumatic cause: trauma by rubbing, allergy by environmental irritants such as exposure to direct sunlight or continued exposure to dryness or small particles, e.g. dust, smoke, grass seed etc. that damage the corneal epithelium. Hypovitaminosis-A has also been suggested as a cause of cornea disorder as well as hypoproteinemia. Acanthamoebae Spp. has been identified in corneal swabs. It's presence has been associated with corneal ulcers (Dangolla, 2005). However, the protozoa was also found in swabs taken from healthy elephant eyes (Wijesekara, 2007). Corneal edema Corneal edema, also called corneal swelling, is a buildup of fluid in the cornea. It is caused by dysfunction of the endothelial membrane on the inner side of the cornea, that normally pumps fluid out of the cornea in order to keep it transparent and clear. This can happen after a blow to the eye or a puncture of the cornea (e.g. by small branches), or by contact with toxic substances. Cornea edema in an Asian elephant. (Photo: KUMar) Cornea edema in an Asian elephant. (Photo: KUMar) Cornea opacities - keratitis Opacities in the cornea are called keratitis and are very common in elephants. They present as whitish, "cloudy" areas usually in the central part of the cornea. It has been suggested that they are caused by trauma (thorns, heat, dust, and chemicals), direct sunlight or chronic dehydration. The cornea must be checked for foreign bodies. In severe keratitis, the entire cornea turns white. This reduces the vision of the animal to only being able to distinguish just between light and dark. This can be tested with the blinking reflex . In some cases, keratitis can be painful: the elephant shows blepharospasm and the third eyelid may be protruded (partly) over the eyeball. In that case involvement of the iris should be considered. It is recommended to perform cytology, aerobic bacterial culture, and sometimes fungal culture. When opacities are only found in the superficial epithelium, and dispersed over the entire cornea surface, it might be the result of hypovitaminosis-A (vitamin A is essential for the normal functioning of the corneal epithelium, including the production of the tear film). This condition is called "xerophthalmia". As fluid makes its way into the cornea it can accumulate and cause the formation of small bullae or "blisters." This is called bullous keratopathy. If the blisters break or rupture, a corneal ulcer will result. Mild, superficial opacity in the central area of the cornea in an Asian elephant (keratitis). (Photo: KUMar) To page top Diffuse, superficial opacities spread over the entire cornea of an Asian elephant, possibly caused by hypovitaminosis-A (xerophthalmia). (Photo: KUMar) Mild keratitis in an Asian elephant. (Photo: KUMar) Severe keratitis involving the entire cornea of an Asian elephant. (Photo: KUMar) Severe keratitis with protrusion of the third eyelid in an Asian elephant. This could be an expression of pain, in which case iris involvement should be considered. (Photo: KUMar) Corneal ulcer A cornea ulcer is an open sore on the cornea. The epithelial outer layer and the middle layer of the cornea (stroma) are disrupted. This condition is also called a melting corneal ulcer. Usually the primary cause is trauma of the cornea. This traumatic lesion can become infected by bacteria (Pseudomonas, Neisseria spp, fungi and other microbes. This condition is very painful a nd blepharospasm is often seen. The elephant may be rubbing the area around the affected eye against an object. There may be protrusion of the third eyelid. An ulcer is usually the result of trauma. Treatment of keratitis with NSAID's or glucocorticosteroids increases the risk of ulceration. As a reaction to the ulcer and to repair the lesion, blood vessels will grow into the stroma of the cornea, visible as small red lines, sometimes forming a network of small vessels. This process takes several weeks. When the cornea surface has been repaired, the remnants of these blood vessels will be visible as white connective tissue strands. The major risk in an ulcerated cornea is perforation of the entire cornea, which will result in loss of the ocular fluids and complete loss of the eye. When blood vessels fail to grow towards the ulcer, the ulcer remains in an unchanged form as an indolent corneal ulcer, needing a special treatment. Two manifestations of a severe keratitis and cornea ulcer with a prolapse of the iris in an Asian elephant. (Photo: KUMar) Hypopyon Hypopyon keratitis is an accumulation of pus (heterophils and fibrin) in the anterior eye chamber (between cornea and lens). It is accompanied by profuse discharge and signs of ocular pain. Ultrasonographic examination may be helpful for diagnosing pus in the anterior chamber. One case report describes the treatment of hypopyon in an Asian bull elephant. Hypopyon and uveitis have been described in a case of leptospirosis (Fowler. 2006. Infectious diseases. In: Fowler and Mikota, 2006, 403). Hypopyon Iris and uvea The iris is a diaphragm that regulates the influx of light. It is a very vulnerable structure that consists of two layers: the outer (anterior) pigmented fibrovascular layer (known as stroma, which lacks an epithelial layer) and the inner (posterior) surface covered by a heavily pigmented epithelial layer that is two cells thick (the iris pigment epithelium). This anterior surface projects as the dilator muscles. The high pigment content of the iris blocks light from passing through to the retina, restricting it to the pupil. The outer edge of the iris, known as the root, is attached to the sclera and the anterior ciliary body . The iris and ciliary body together are known as the anterior uvea . Uveitis Any lesions in the anterior part of the eye can result in damage to the iris. Parts of the affected iris may come into contact with the inner layer of the cornea (anterior synechia) or the lens (posterior synechia). If there is also a corneal ulcer, the iris may prolapse through the ulcer (iris prolapse). Iris lesions are considered to be very painful in all animal species. These conditions need immediate veterinary attention. Lesions of the iris and uvea are called uveitis . If only the anterior part is involved, we call it iritis . In reality it will be hard to distinguish these conditions in elephant ophthalmology, unless proper ophthalmoscopy can be performed under sedation or general anesthesia. Lens The lens is a transparent biconvex structure in the eyes that, along with the cornea , helps to refract light to be focused on the retina . Any lesions of the lens will result in white discoloration and loss of transparency (cataract). This is seen as a white area in the central pupillary space. Young cataracts will appear as cloudy structures. A mature cataract appears as a completely white pupil. A complete, mature cataract will reduce the vision of the elephant which may finally result in complete blindness of the affected eye. When an elephant is approached on the side of the blind eye, the clinician should be aware of the compensating behavior of the elephant, when it tries to keep its functional eye on the investigator. Cataracts are quite common in Asian elephants in range countries. One paper notes that 6-8% of the elephants kept in Sri Lanka suffer from this condition (Kuruwita, 1991). Several causes of cataracts are known in other animal species: trauma, overexposure to sun light, deficiency of vitamin A, C, E or riboflavin, diabetes and dehydration. Often the cause of a cataract in elephants cannot be determined. Early stage of a cataract in an Asian elephant. (Photo: KUMar) Advanced stage of a cataract in an Asian elephant. (Photo: KUMar) Advanced stage of a cataract in an Asian elephant. (Photo: KUMar) Panopthalmitis and phthisis bulbi Panophthalmitis is inflammation of all layers of the eye including the intraocular structures. It has been documented in nine eyes postmortem during a field study of eye lesions in African elephants ( McCullagh, 1969). Phthisis bulbi is a shrunken, non-functional eye. It may result from severe eye disease, inflammation or injury. Phthisis bulbi after chronically infected cornea ulcer. (Photo: KUMar) Subdermal injection of Plancentrex (0.1 mg/ml) in an Asian elephant with uveitis. (Photo: KUMar) Summary of the most frequently used drugs in ophthalmology Standard frequency of treatment applications: 3-5 per day Antibiotic treatment should be based on sensitivity test Flushing with 0.9% NaCl solution is recommended before every topical drug application The elephant's eye can be flushed using a long, small diameter tube place on a syringe. (Photo: KUMar) Treatment options in elephant ophthalmology Blepharitis: Treatments of blepharitis in elephants have not been described in the literature. A similar approach as in other mammals is recommended: elimination of the cause (parasites, dermatitis) and flushing the eye (see photo below) with saline solution, 3-5 times a day. Conjunctivitis, prolapse of the conjunctival sac : elimination of the cause and flushing the eye with saline solution, 3-5 times a day and antibiotic ointment, 3-5 times a day. Corneal edema: flushing with a hypertonic saline solution, 3-5 times a day. Keratitis in early stage: flushing with saline solution, 3-5 times a day, antibiotic ointment, 3-5 times a day. If there is no ulceration, topical application of 0.1% dexamethasone eye drops may be used; be aware that corticosteroids will stop the regeneration of the epithelial cells. Chronic keratitis: treatment will have no effect. Xerophthalmia: oral vitamin A supplementation. Corneal ulcer: flushing with saline solution, and topical application of antibiotic eye ointment 3-5 times a day. Topical application of Diclofenac sodium 1% eye solution may help reducing the pain. Promising results of the use of autologous serum have been reported (Janyamethakul, 2015), applied twice daily. Preparation of autologous serum: Five 10 ml. syringes were used to collect a total of 50 ml. Then, the blood was allowed to clot for 2 hours at room temperature before being centrifuged at 3,000 rpm for 15 minutes. The separated serum was collected (about 20-25 ml.) into a sterile container to which 1 mg. of gentamicin was added. The autologous serum was then aliquoted into sterile tubes, each containing 3 ml. Additionally, the serum was stored at 4°C and used within 7 days. Topical treatment with acetylcysteine (0.02%) was used in case of a corneal abscess along with gentamycin and atropine (Pipitwanichtham, 2023). Other treatments attempts that have been tried: Indolent (non-healing) corneal ulc ers are hard to treat. Debridement of necrotic corneal stro ma should be considered. This can be done by using a cotton tip, or in more severe cases the abnormal cornea tissue can be scraped using a corneal spatula. Theoretically, after the debridement, the cornea should be protected by a contact lens as used in horses. This has been repo rted once in a 44 yrs-old Asian elephant, in which case the lens was lost soon after application. In elephants flushing the eye and applying antibiotic eye ointment and autologous serum is probably the only possible post-debridement treatment. Stem cell application: pr omising results were seen at the Elephant Conservation Center Lampang (Thailand). Although never reported in elephants, the application of a few droplets of cyano-acrylate might be an alternative for a contact lens in elephants. Hypopyon: pain relief (NSAID), systemic antibiotics (DDX: leptospirosis!). Uveitis and Synechia: Atropine sulfate eye ointment (1%), 4-6 times a day, is a commonly used mydriatic drug in horses. It may stabilize the blood-aqueous barrier, reducing vascular protein leakage, minimizing pain from ciliary muscle spasm, and reducing the chance of synechia formation by causing pupillary dilatation. Pupil dilation is an indicator for the drug to be effective on the ciliary muscles. In horses even topical atropine has been shown to prolong intestinal transit time, reduce and abolish intestinal sounds, and diminish the normal myoelectric patterns in the small intestine and large colon of horses. Whether this also applies to elephants is unknown. Subdermal injection of placental extract (Placentrex®) is a common treatment for uveitis, hypopyon and corneal opacities in elephants in Asia (Suedmeyer, 2006). See also photo below. Iris prolapse: systemic NSAID, flushing with saline solution, 3-5 times a day. As the cornea is perforated by the prolapsed iris, the elephant should be treated systemically with antibiotics. Cataract: only 2 cases of (mature) cataract removal by phaecoemulsification have been reported (cataract surgery-UK and cataract surgery-USA). However, artificial lenses to replace the removed lens contents are not available. The significant lens instability (first noted following the initial stages of surgery in the USA-case, i.e., during creation of the anterior capsulorhexis) prevented implantation of an intraocular lens implant. See for more detailed information the references below (Cerrata, 2019 and Manchip 2020). Panophthalmitis: Enucleation is the only treatment indicated for this condition. However, there are no published data on the treatment of panophthalmitis. Placentrex Flushing References and further reading: Bapodra P, Bouts T, Mahoney P, Turner S, Silva-Fletcher A, and Waters M. 2010. Ultrasonographic examination of the Asian elephant (Elephas maximus) eye. Journal of Zoo and Wildlife Medicine , Vol. 41, No. 3, 409–417. Cerreta, A.J., McMullen Jr R.J., Scott, H.E., Ringenberg, J.R., Hempstead, J.E., DeVoe, R.S., Loomis, M.R., and Minter, L.J.. 2020. Bilateral Phacoemulsification in an African Elephant (Loxodonta africana). Hindawi Case Reports in Veterinary Medicine Volume 2019, Article ID 2506263, https://doi.org/10.1155/2019/2506263 or click here to download the manuscript. Dangolla A, JS Edirisinghe and ID Silva (2005). Association of Acanthamoeba with a corneal ulcer in a captive elephant (Elephas maximum maximus). Proceedings of 57th Annual Convention and Scientific Sessions of the Sri Lanka Veterinary Association. 33pp Fowler M. 2006. Infectious diseases. In: Biology, Medicine and Surgery of Elephants, Ed. Fowler and Mikota, 148. Janyamethakul T, Moleechat P, Gohain R, Somgird C, Pongsopavijit P, and Wititkornkul B. 2015. Efficacy of Autologous Serum as An Adjunct Treatment for A Melting Corneal Ulcer in A Captive Asian Elephant. Thai Journal of Veterinary Medicine: Vol. 45: 2, Article 18. Kraiwong, N., P. Sanyathitiseree, K. Boonprasert, P. Diskul, P. Charoenphan, W. Pintawong and A. Thayananuphat (2016). "Anterior ocular abnormalities of captive Asian elephants (Elephas maximus indicus) in Thailand." Vet Ophthalmol 19(4): 269-274. Kuruwita VY and Abeysinghe AB. 1991. Surgical correction of blindness due to mature cataract in a domesticated Asian elephant. International Seminar on Veterinary Medicine in Wild & Captive Animals, Bangalore, India, November 8 to 10, 1991; 23 Manchip, K.E.L., Sayers, G., Lewis, J.C.M., and Carter, J.W. 2019. Unilateral phacoemulsification in a captive African elephant (Loxodonta africana). Open Veterinary Journal, (2019), Vol. 9(4): 294–300. ISSN: 2218-6050 (Online) DOI: http://dx.doi.org/10.4314/ovj.v9i4.3 . or click here to download the manuscript. McCullagh, K.G. and Gresham, G.A. 1969. Eye lesions in the African elephant (Loxodonta africana). Res Vet Sci 10(6): 587–589. Pipitwanichtham S, Dittawong P, Meetipkit P, Sitdhibutr R, Pattanapon N, Kasornsri M, Phetudomsinsuk K, Thongtip N, Sripiboon S. Case report: Corneal stromal abscess in a captive Asian elephant: diagnosis and treatment regimes. Veterinary Integrative Sciences 2023; 21(3): 693 - 703 DOI; 10.12982/VIS.2023.050 . Suedmeyer Wm. K. 2006. Special senses. In: Biology, Medicine and Surgery of Elephants, Ed. Fowler and Mikota, 399-403. Use of a contact lens for horses in an Asian elephant (PDF) Wijesekara PNK, Bandara KAPA, Dangolla A, Silva ID and Edirisinghe JS. 2007. Incidence of Acanthamoebae Spp . in the eyes of a group of captive elephants in Sri Lanka. Conference: International Elephant Conservation & Research Symposium Florida USA At: Orlando, Florida USA, November 2007. Wong MA, Isaza R, Cuthbert JK, Brooks DE and Samuelson DA. 2012. Periocular anterior adnexal anatomy and clinical adnexal examinaton of the adult Asian elephant (Elephas maximus) . Journal of Zoo and Wildlife Medicine , Vol. 43, No. 4, pp. 793-80. To page top

The dashboard is the central page of this website where you can find all topics available. Dashboard Infectious diseases Case reports Nutrition Non-infectious diseases Reproduction Laboratory diagnosis Behavior & Training Physical examination Handraising orphans Hand-raising orphans (To: ECI website) Preventive medicine Drug formulary Drug formulary (To: ECI website) Post-mortem examination Procedures Documents

Serum chemistry data in elephants can provide valuable information about organ function (liver, kidney, muscles, intestines, pancreas) and disease conditions (inflammation, infection), hormone levels and toxins. Proteins, AST, ALT, GGT, creatinine, bilirubin, CK, LDH, Ca, P, glucose, Na, Cl, K are part of the comprehensive chemistry panel. To lab diagnosis Blood chemistry Reference values blood Serum/plasma chemistry Refractometry Serum/plasma Chemistry Serum quality Ser um quality Serum chemistry data may help determining the function of certain organ systems. The reliability of the results largely depend on the quality of the sample. Before running any biochemistry tests, the blood should be well clotted, preferably without hemolysis (shown as red colorat ion of the serum). Chemistry data are usually obtained from serum. Some tests can also be run usi ng plasma. Before using plasma, this option should be checked with the test instructions. Test tubes to be used: red-topped serum-tubes with or without a clotting activator. The color of the serum should be light yellow. The figure below shows different serum characteristic: Hemolysis: Red to brown color due to hemolysis (destruction of erythrocytes). This can have a pathological origin or can result from poor sampling/handling; the red-brown color can also be caused by myoglobin after massive muscle damage (rhabdomyolysis) Milky white color due to presence of fat particles in the serum (physiologic shortly after eating or pathological condition) Yellow color due to the presence of bilirubin (liver damage ->icterus). Blueish-red color due to methemoglobin (low venous oxygen saturation). Lipemia Lipemia, which can be a natural occurrence if the elephant has just eaten, can alter several test results. Calcium, phosphorus, total bilirubin or hemoglobin may be falsely elevated. When using a refractometer to measure the total protein remember that the serum must be clear. If not the value may be falsely elevated. Albumin, sodium and potassium may be falsely lower. Lipemia also enhances hemolysis which in turn can affect lab results. But there is a solution: If you refrigerate your sample the lipemic portion will separate and you can use the clear aliquot below the lipid layer. Normal and lipemic elephant serum Reference values Normal serum chemistry values are determined by species, age, gender and reproductive status of the elephant. It is important to have an understanding of the limitations of laboratory values. The term “reference value” is now considered a more appropriate term than “normal value.” Ideally reference values should be established from studies using a minimum of 30 healthy animals and stated selection criteria. Few elephant studies have been conducted to meet this standard. One report describes chemistry results for different genders of Asian elephants used for logging in Myanmar (Santo, 2020). Moreover, many reference ranges are laboratory specific. So it is best to use one laboratory that can help to develop reference ranges for your elephants. Another important point is that a test result that falls outside of the reference is not necessarily clinically significant. Lab values are information that must be used with all the other information that you have when you are faced with a sick elephant. Establishing a baseline during health and performing sequential tests during illness will give the most reliable information. You also want to use a lab that has good quality controls. If you change labs it is advisable to get new healthy baselines. V ery odd results should always be double checked at the same lab. To page top One study in 10 healthy Asian elephants showed that most Asian elephant hematology and biochemistry parameters are highly individual, requiring individual normal values for accurate interpretation (Perrin, 2020). Test result units Another complicating factor when looking at serum chemistry values is that there is a lack of uniformity regarding units and this can be confusing. Most U.S labs use conventional units whereas in Europe they use SI units. There are conversion factors to go from one system to the other but the conversion factor is test specific – so each test has a different conversion factor. You can find SI conversion calculators online, i.g. ht tps://www.amamanualofstyle.com/page/si-conversion-calculator. Liver The liver plays an important role in the following processes: Protein synthesis and degradation (albumin, clotting factors) Carbohydrate and lipid metabolism Breakdown of hemoglobin Storage (fat soluble vitamins) Detoxification Liver enzymes: Aspartate aminotransferase (AST; SGOT) Alkaline phosphatase (ALP) γ-glutamyl transferase (GGT) Bilirubin Bile acids (?) BSP excretion (bromsulphthalein) AST (SGOT) Aspartate aminotransferase, previously known as serum glutamic oxaloacetic transaminase (SGOT) occurs in all cells. Highest levels are in the liver, cardiac muscle, and skeletal muscle. If AST is elevated then you should also look at the creatine kinase (CK) value. If the CK is normal then AST is likely of liver origin. If the CK is elevated or there is obvious muscle trauma then AST may be of muscle origin. Also AST may falsely increase if the sample is hemolyzed. ALP Alkaline phosphatase is also found in all cells with the highest levels in liver, bone, kidney, intestine, and placenta. ALP is not a sensitive indicator of liver disease in the horse and this probably holds true for elephants although research would be needed to confirm this assumption. ALP may increase with disorders such as rickets. ALP levels are normally higher in young animals including elephants. ALP may indicate colostrum absorption. Non-steroidal anti-inflammatory drugs may cause ALP to elevate. GGT Gamma glutamyl transferase (GGT) is liver specific in horses and pigs. Whether it is liver specific in elephants is unknown. GGT is an indicator of cholestasis (the interruption of bile excretion). GGT has been shown to increase in musth bulls and it has been used together with ALP as an indicator to evaluate passive transfer of antibodies to neonates via colostrum. Bilirubin There is not much information about bilirubin in elephants. There are two forms: unconjugated and conjugated bilirubin. The unconjugated is the main form in horses so this may be true for elephants but we don’t know for sure. Unconjugated (indirect) bilirubin is mainly hemoglobin released from old erythrocytes. It is bound to albumin and transported to the liver where it is conjugated. Conjugated (direct) bilirubin is secreted into bile, transferred to the intestine, converted to urobilinogen by intestinal bacteria, and excreted. Elevated bilirubin may be caused by hemolysis; hepatocellular disease that results in reduced functional mass; and intra - or extrahepatic cholestasis or bile duct obstruction. Unconjugated bilirubin predominates in horses with hyperbilirubinemia regardless of etiology whereas in ruminants unconjugated bilirubin is typical. In one report, elevated total bilirubin (4.94 mg/dl) was observed in a female Asian elephant with colic caused by over-zealous feeding of produce. Values for indirect and direct bilirubin were 3.7 mg/dl and 1.2 mg/dl respectively. Tests of hepatic uptake, conjugation and excretion of bilirubin. Diagram from Lattimer, K.S., Mahaffey, E.A., and Prasse, K.W. 2003. Clinical Pathology 4th edition. Blackwell. P.199. Bile acids Bile acids assist with fat digestion. In most species, bile acids are stored in the gall bladder and released into the intestine. However, elephants do not have a gall bladder. There is controversy whether elephants have bile acids. In several cases bile acids were shown to increase in elephants with TB. Bromsulphthalein (BSP) excretion test In the BSP test a dye is injected IV and measured at several points in time post-injection. In the horse, the half-life is 3.5 minutes. Slow clearance time may indicate cholestasis. Although levels have been shown to increase with liver flukes in elephants, it is not a very practical test. Kidney Blo od Urea Nitrogen ( BUN) and creatinine are the main enzymes used to evaluate kidney function in mammals. BUN Elevations in blood urea nitrogen concentration may be due to prerenal causes like inadequate renal perfusion, shock, or diminished blood volume; renal causes like glomerular-nephritis; or postrenal causes like urinary tract obstruction. Blood Urea Nitrogen makes up approximately 75% of the total non-protein nitrogen (NPN) fraction of the blood. BUN is the major end product of protein nitrogen metabolism. It is synthesized by the urea cycle in the liver from ammonia which is produced by amino acid deamination. Urea is excreted mostly by the kidneys, but minimal amounts are also excreted in sweat and degraded in the intestines by bacterial action. Creatinine Creatinine only elevates when disease is severe and there is marked kidney damage. Unfortunately, in elephants these enzymes are not always useful to predict kidney disease. Creatinine may be lower in young elephants; higher in musth bulls. Serum osmolality/urine osmolality. The osmolality reflects the total number of electrolytes in a fluid. To keep the number constant, the kidney excretes the surplus that is present in the liquid fraction of the blood and the osmolality ratio between these two fluids should be <1. If the kidneys fail to maintain this equilibrium, the serum-urine osmolality ratio becomes > 1. Serum dimethyl arginine (sDMA). In domestic animals sDMA is a marker for endothelial dysfunction and early diagnose of renal disease (declining glomerular filtration rate). In one case report it was associated with kidney failure (polycystic kidney disease). To page top These values are from an Asian bull elephant with capture myopathy. The elevations in SGOT and CK are dramatic. ALT (SGPT) did not increase as much but is probably significant. The elevations in BUN and creatinine may have been related to capture myopathy however this bull was chained to a tree and not given access to food or water post-capture so these changes may reflect dehydration. Muscles Muscle enzymes are: Creatine Kinase (CK) Lactate Dehydrogenase (LDH) Aspartate Aminotransferase (AST; SGOT) Alanine Aminotransferase (ALT; SGPT) Evaluating muscle enzymes can help to diagnose muscle pathology. Conditions that may cause elevated muscle enzyme levels include prolonged recumbency, rhabdomyolysis (also called over-exertion, or tying up syndrome), and clostridial myositis. Bacterial endocarditis, and aortic thrombosis are other causes as well as Vit E/Se deficiency and capture myopathy. Working elephants may be at risk for muscle over-exertion disorders especially as the planet heats up. In all of these conditions, muscle cell membranes rupture and enzymes are released into the blood. Conditions that may lead to increased muscle enzymes in serum are: Prolonged recumbency Rhabdomyolysis Clostridial myositis Bacterial endocarditis Aortic thrombosis Vitamin E/ selenium deficiency Capture myopathy Creatine kinase (CK) CK is critical to muscle energy production. Highest levels are in skeletal muscle, cardiac muscle, and brain. Most CK in the serum is of muscle origin and it is the most sensitive indicator of muscle damage. CK rises quickly – within hours. It also returns to normal quickly as long as there is no on-going damage. Levels that remain high indicate an on-going disease process. Hemolysis interferes with the test and causes falsely elevated values. Lactate d ehydrogenase (LDH) LDH is present in all tissues. Muscle, liver, and red blood cells are the usual sources. LDH is not as useful for determining muscle damage because it is not muscle specific. If LDH is elevated and there is no muscle injury then liver problems should be considered. Like CK, LDH will be falsely elevated in the presence of hemolysis. Aspartate aminotransferase (AST) AST was previously known as serum glutamic oxaloacetic transaminase (SGOT). Muscle and liver are the major sources. It is another enzyme to check if muscle damage is suspected. Alanine aminotransferase (ALT) ALT, also known as serum glutamic pyruvic transaminase or SGPT, is considered muscle specific in large domestic animals. Increased levels have been associated with myopathies in a number of species. ALT will increase in recumbent elephants that are down for a long time. Severe muscle damage can occur in case of Capture Myopathy: To page top Calcium Ionized calcium This electrolyte that is involved in many chemical reactions in the body. The active form is ionized calcium (Ca2+) and this parameter gives the best impression of the available calcium. To measure ionized calcium, special heparinized tubes are needed . Ionized calcium should be > 1.5 mmol/L (>5 mg/dL). Low ionized calcium levels are associated with prolonged parturition and dystocia. Total calcium Non-ionized calcium is predominantly conjugated with albumins and expressed as total calcium. Higher levels of total calcium have been reported in very young elephants and in elephants with TB and severe kidney disease. Many pregnant captive elephants develop subclinical hypocalcemia if calcium is not supplemented during pregnancy. When parturition starts, the demand of calcium is high as it essential for uterine contractions that open the cervix and help expel the calf. Calcium is also high in milk. Calcium supplementation during pregnancy is recommended to form a stock supply. However, releasing stock-calcium ions from the bones is a very slow process, so the blood itself should contain enough calc ium conjugated to albumin to supply the uterus and body muscles for these hours of high demand. Total calcium levels lower than 1.5 mmol/l (6 mg/dl) result in recumbency and levels less than 1 mmol/l (4 mg/dl) will result in death. Low total calcium levels are associated with prolonged parturition and dystocia. Total calcium should be 2.8 +/- 0.2 mmol/L (11 +/- 0.8 mg/dL). Other minerals and electrolytes Sodium (Na) Potassium (K) Chloride (Cl) The reference ranges of these electrolyte in elephants are similar to other species and can best be compared with horse values. To page top Proteins Elephants have a higher to tal protein serum level than most mammals; albu min is lower, and globulins are higher. The ratio of albumin to globulin was shown to be lower in one study that compared elephants with and without TB however the number of TB positive elephants in the study was low. Protein electrophoresis separates the albumin and globulin fractions. There are not many reports in elephants. Protein electrophoresis may be useful to monitor inflammatory conditions or problems like TB, herpes, and others. Acute Phase Proteins Acute phase proteins (APPs) are components of the innate immune system that are markers for infection, inflammation, neoplasia, and tissue injury in humans and domestic animals. APPs are produced by the liver in response to cytokines released from leukocytes. They are initially released into serum 24–96 hr following an acute inflammatory stimulus, where they function to promote healing, reestablish homeostasis, and inhibit microbial growth. The main ones are C-reactive protein (CRP) , serum amyloid (SAA) and haptoglobin (HA) . In one study serum samples from 35 healthy Asian elephants were analyzed for these 3 APPS and levels between the values in healthy and unhealthy elephants were compared (Isaza et al., 2014). From this and other studies it seems that SAA may be the most responsive APP in elephants. The APP values in this study in Asian elephants are shown here: C-reactive protein 12.4-122 nmol/l (1.3-12.8 mg/l) Serum amyloid 0-47 mg/l Haptoglobin 0-1.1 mg/l Glucose Glycolysis of glucose in serum or plasma will decrease the glucose level starting shortly after blood collection. Serum or plasma should therefore b e separated from the red blood cells within 30 minutes after collection. Glycolysis can be prevented by using a Na-fluoride tube for blood collection. Significantly lower levels have been noted in one study comparing TB culture positive and negative elephants. In horses, hypoglycemia may be seen with hepatic failure or bacteremia. There is one report of diabetes mellitus in a 50-yr-old Asian elephant (van der Kolk 2011). Hyperadrenocorticism and hyperthyroidism have not been reported in elephants. Increased blood glucose in elephants is likely to be transient. Some of the causes of transient hyperglycemia could be a cute severe colic acute stress, p ost-postprandial, certain drugs (s teroids, x ylazine, p henothiazine) . Hypoglycemia can occur in n eonatal elephants and in cases associated with m alnutrition, m alabsorption, s epsis, e xtreme physical exertion, a dvanced liver disease or n eoplasia. Amylase and lipase Ranges for these enzymes vary tremendously depending on the methodology and the lab so at this point in time they are not very useful tests for elephants. Amylase may increase in case of pancreas, gastro-intestinal, liver and kidney disease Lipase may increase in case of pancreas or kidney disease. One case of pancreatitis in an elephant has been described so far (pers. comm. Susan Mikota, 2023). Lactate Lactate is an important serum parameter to monitor severe, life-threatening conditions in elephants, like septicemia, Disseminated Intravascular Coagulopathy in a EEHV-HD case. Normal values are between 0--0.11 mmol/L (0-1 mg/dL). Values >0.44 mmol/L (4 mg/dL) are indicative for perfusion problems due to DIC. EEHV-HD patients often have lactate value > 0.22 mmol/L (2 mg/dL) (Wiedner, pers. comm. 2022). A comprehensive elephant serum chemistry panel should include: Total protein Albumin BUN Creatinine AST (sGOT) ALT (sGPT) GGT Bilirubin Bile acids (?) CK LDH Na Cl K Ca P Lactate To page top References Steyrer C, Miller M, Hewlett J, Buss P and Hooijberg EH (2021) Reference Intervals for Hematology and Clinical Chemistry for the African Elephant (Loxodonta africana). Front. Vet. Sci. 8:599387 Santos DJ, Franco dos J, John, Nyein UK, and Lummaa VM. 2020. Sex differences in the reference intervals of health parameters in semi-capt ive Asian elephants ( Elephas maximus ) from Myanmar. J.Zoo&Wildl Med 51(1): 25–38 Debbie JG and Clausen B. 1975. Some hematological values of free-ran ging African elephants. Journal of Wildlife Diseases, 11(1):79-82. Isaza R, Wiedner E, Hiser S, Cray C. 2014. Reference intervals for acute phase protein and serum protein electrophoresis values in captive Asian elephants (Elephas maximus ). J. of Vet. Diagn. Invest. 1-6 Perrin, KL, Kristensen AT, Gray C, Nielsen SS, Bertelsen MF, Kjelgaard-Hansen M. 2020. Biological variation of hematology and biochemistry parameters for the Asian elephant (Elephas maximus ), and applicability of population derived reference intervals. Journal of Zoo and Wildlife Medicine, 51(3) : 643-651. Van der Kolk JH, Hoyer MJ, Verstappen FALM, Wolters SABI, Treskes M, Grinwis GCM and Kik MJL (2011). Diabetes mellitus in a 50-year-old captive Asian elephant (Elaphas maximus ) bull, Veterinary Quarterly, 31:2, 99-101. Https://doi.org/10.1080/01652176.2011.585793 To page top

Locomotion problems in elephants are usually symptoms of degenerative joint diseases and lesions of the pad or nail. This chapter describes (1) the diagnosis of orthopedic problems (observationa and video recording, radiology, thermology), (2) nail issues, (3) sole/pad issues, (4) degenerative joint disease and some miscellaneous problems related to lameness. Continue Orthopedic problems This chapter consists of the following paragraphs: Normal features of the locomotion system Sole-related clinical problems Nail-related clinical problems Lameness / abnormal locomotion Prevention of orthopedic problems Radiography elephant foot Regular foot care Elephants do not often show signs of lameness. Nevertheless, orthopedic problems are quite common. A survey about the causes of death in the European studbooks of African and Asian elephants over 5 years of age, revealed that in 12% and 30% respectively of the cases, orthopedic problems played a major role in the cause of death (Hess 2022). The most frequently reported problems are related to the feet, joints and muscles. A special issue is the occurrence of metabolic bone disease in bottle-raised young elephants. Normal features of the locomotion system Normal featurs Anatomical features of the skeleton The elephant has some special features that distinguishes them from other mammals. The long bones are massive, lacking the typical bone marrow cavities. Instead, the long bones of elephants are completely filled with dense cancellous bone, where hemopoiesis is taking place. In the standing elephant, the angles of the joints are almost straight. The neck is relatively short. Figure 1: Asian elephant (Green Hill Valley, Myanmar). Figure 2: African elephant skeleton (Veterinary Faculty Utrecht University, the Netherlands) Foot anatomy terms Front foot = fore foot = manus Hind foot = rear foot = pes Phalanges = toes = digits Pad = sole = slipper Palmar = front pad Plantar = back pad Carpus = wrist Tarsus = ankle Nail = horn wall + nail pad horn Fat cushions Each foot of the elephant is equipped with a large subcutaneous cushions which play an important role in distributing forces during weight bearing and in storing or absorbing mechanical forces. One study about these cushions in the African elephant was published by Weissengruber in 2006 . In both the forelimb and the hindlimb a 6th ray, the prepollex or prehallux, is present. These cartilaginous rods support the metacarpal or metatarsal compartment of the cushions. None of the rays touches the ground directly. The cushions consist of sheets or strands of fibrous connective tissue forming larger metacarpal/metatarsal and digital compartments and smaller chambers which are filled with adipose tissue. The compartments are situated between tarsal, metatarsal, metacarpal bones, proximal phalanges or other structures of the locomotor apparatus covering the bones palmarly/plantarly and the thick sole skin. Within the cushions, collagen, reticulin and elastic fibres are found. In the main parts, vascular supply is good and numerous nerves course within the entire cushion. The high concentration of sensory receptors such as Vater–Pacinian corpuscles within the cushion and Meissner corpuscles in dermal papillae of the adjacent skin might rank an elephant’s foot among the most sensitive parts of its body. Together, the mechanical and sensory functions of the feet enhance the ability of elephants effectively to move through and analyse their physical environment. The micromorphology of elephant feet cushions resembles that of digital cushions in cattle or of the foot pads in humans but not that of digital cushions in horses. Copied illustration of the foot anatomy from Weissengruber et al., 2006 (doi: 10.1111/j.1469-7580.2006.00648.x Normal locomotion Elephants predominantly support on their pads (foot soles). The nails are not used to force locomotion. This is nicely demonstrated in the slow-motion video below (BBC). During walking the head of the elephant shows minimal movements. If there is any form of lameness, especially in one of the front legs, the animal might use its head to facilitate the movement of the front leg in cranial direction. In the absence of orthopedic problems, the hind feet are placed cranial to the foot step of the front foot on the same side. This is clearly demonstrated in the slow-motion video of African elephants in the Namibian desert below (BBC) and the normal-speed video of an adult Asian elephant bull in Vietnam. Elephants can't trot, canter, gallop or jump. They always walk in normal gait, placing their hind foot in the foor print of the front foot or even slight more cranial. When they walk slowly, their speed is approximately 4 km/h (2.5 miles/h). However, they can reach a speed of 25 km/h (15.5 miles/h) over a short distance (Hutchinson 2006). Higher speeds are often mentioned in publications, but there is no scientific evidence for such statements. Normal anatomical features of the elephant foot Usually the forefeet of the Asian elephant have 5 nails and the hind feet only 4. The African elephant has 4 nails on the forefoot and 3 on the rear one. The weight of the body is evenly distributed over the toes by means of a thick cushion , placed between the sole and the phalanges (photo African elephant foot Kruger National Park, South Africa). The digits form a ±45° angle with the sole, as shown in the radiograph below (Fowler and Mikota 2006). This photo shows the longitudinal section of the elephant foot with the sole, nail, phalangeal bones, cushion and tendons. Note the short distance between the nail and the distal phalangeal bone (Fowler and Mikota 2006) The nails are numbered medial to lateral. If there are 4 nails in front they are numbered 2,3,4,5. The bones don’t change – there are always 5 digits so digit 1 is still there but there in no associated nail. In Asian elephants there are typically 4 nails on the rear foot so they are numbered 2,3,4,5. The African elephant's toes are numbered 5,4,3,2 (front) and 5,4,3 (rear) respectively. This diagram shows the bones of the front foot and the respective phalanges of an Asian elephant (Fowler&Mikota 2006) This diagram shows the bones of the hind foot and the respective phalanges of an Asian elephant (Fowler&Mikota 2006) Radiograph of the left front foot of an Asian elephant, showing the phalangeal bones P1,P2 and P3 (Fowler&Mikota 2006) Sixth toe The elephant has unique cartilaginous structures in the feet that are thought to have a stabilizing function. In the front foot the structure is is called a prepollex. It attaches between the first carpal bone and the first metacarpal bone and extends to the sole. In the hind foot it is called a prehallux. A recent study has claimed that this structure should be considered a sixth toe because over time the tissue becomes hard like bone. The healthy sole The sole (pad or slipper) of the elephant's foot is a thick cornified but flexible integumentory structure, with a surface relief that looks almost similar to the skin. It is important to respect this surface when performing pedicure. The thick sole must protect the elephant from penetrating trauma by foreign bodies. A healthy sole is maintained by providing a dry environment. Long periods in muddy and humid circumstances can lead to sole injuries and even sole detachment. The photos show the nicely structured sole of a (dead) wild African elephant (Kruger National Park, South-Africa) and the sole of a captive Asian elephant. The sole of the elephant foot should have a minimum thickness of 2 cm. This can be measured by ultrasound examination. Its surface should be rough with a distinct relief. The growth of the sole epithelium is from 0.5 to 1.0 cm per month. If the sole does not wear sufficiently, it becomes thickened, and because the thickening is seldom uniform, defects are produced that lead to pocket formation and overgrowth, which sets the stage for infection. The healthy nail The nail consists of two parts: the wall and the sole part, which are connected at the sole side. This junction is an important area where infections can emerge if its integrity has been severed by excessive abrasion on hard floors (concrete stable, tar roads) or wrong pedicure. This connection site is comparable with the so-called 'white zone' in hoofed mammals. The white line (or white zone) structure is illustrated in the figures and photos below (Benz, 2005). The nails should be shorter than the pad, without cracks and U-shaped. The skin in between 2 nails should be clean and flexible. When there is hyperkeratosis in this area, this may cause discomfort to the elephant as the hard hyperkeratotic tissue acts as a foreign body by pinching the interdigital skin an dirt can accumulate into the interdigital space. There should be room for at least one finger between 2 nails. The thermographic images of a healthy nails shows a regular distribution of the temperature dispersed over the entire nail. Like in hoofed mammals, the nails are connected with the underlying phalanges by lamellae or horn leaflets. Benz (2005) describes the different parts of the nail: a: corial part of the horn wall: cuticle area b: lamellae (horn leaflets) c: white zone d: sole horn Cuticle and sweat glands The cuticle of the nail is the keratinized skin at the junction with the nail. They should be soft and flexible. This is a vulnerable area as microorganisms may pass this natural barrier after (micro)trauma. The elephant seems to maintain the cuticles by rubbing them gently against objects. Elephants that are kept in moist, muddy conditions, are likely to develop problems with the cuticles. They may overgrow and become hardened when they dry, resulting in cracks and infection. During pedicure, one should be well aware of the protecting function of the cuticles and never remove more than necessary. References Benz, A. 2005. The elephant’s hoof: Macroscopic and microscopic morphology of defined locations under consideration of pathological changes. Master's thesis, Veterinary Faculty of the University Zürich, Switzerland. Fowler M.E. and Mikota S.K. 2006. Biology, Medicine, and Surgery of Elephants. 271-290. Hess A. 2022. Lesions found in the post-mortem reports of the Asian (Elephas maximus) and African (Loxodonta africana) elephants of the European Association of Zoos and Aquaria Master's thesis, Department of Exotic Animal and Wildlife Medicine University of Veterinary Medicine Budapest, Hungary. Hutchinson JR, Schwerda D, Famini DJ, Dale RHI, Fischer MS, & Kram R. (2006). The locomotor kinematics of Asian and African elephants: changes with speed and size. Journal of Experimental Biology, 209, 3812-3827 . Nigam, P., Sarma, K.K., Kumar S. and Pandey, R. (Eds.) 2025. Healthy Feet, Healthy Elephants: A Guide to Foot Care in Captive Asian Elephants . Project Elephant Division, MoEF&CC, GoI- Wildlife Institute of India. Schiffmann C. 2021. Posture Abnormalities as Indicators of Musculoskeletal Disorders in 12 Zoo Elephants – a Visual Guide. Gajah 53 (2021) 20-29. Weissengruber, G.E., Egger, G.F., Hutchinson, J.R., Groenewald, H.B., Elsässer, L., Famini, D. and Forstenpointner, G. (2006), The structure of the cushions in the feet of African elephants (Loxodonta africana). Journal of Anatomy, 209: 781-792. https://doi.org/10.1111/j.1469-7580.2006.00648.x To page top

This page directs you to the following reproduction-related topics in elephants: -estrous cycle -normal birth process -vaginal vestibulotomy -tumors and cysts in the reproductive organs -cesarian -dystocia -fetal retention -infertility (female) -infertility (male) To dashboard Reproduction Estrous cycle Endoscopy urogenital tract Pregnancy confirmation Normal birth process Dystocia Vaginal vestibulotomy Fetotomy Tumors and cysts I need your input to write these chapters: Cesarian Infertility (female) Infertility (male)

Elephant dentistry is an important part of elephant medicine. Molars may develop in the wrong direction resulting in abnormal wear. Parts of old molars may dealy in falling out, resulting in pain. Tusk issues are common in Asian bulls and both genders of Arican elephants: fracture, fussure pulpitis, sulcus infection. To non-infectious diseases Dentistry TUSKS MOLARS Fissure/longitudinal crack Molar tooth issues Tusk fracture Pulpitis (needs your input) Sulcus trauma after fracture Sulcus infection Supernumerary tusk Tush loss (female elephant) Tusk extraction (needs your input) https://www.mondulkiriproject.org/blog/elephant-teeth/ To page top

Necropsy index Necropsy pictural guide Necropsy procedure (videos) Necropsy protocol forms

Back to dermatology To reproduction Back to dermatology Case report Vaginal vestibulotomy and wound treatment Date: 1993 Place: Rotterdam Zoo Data provided by: Willem Schaftenaar HISTORY An uneventful first pregnancy (677 days) in a 29 years old Asian elephant ended in complete stagnation of the birth process. A 20x30 cm piece of fetal membrane tissue was found in the enclosure. Over 100 hours of strong labour activities did not result in progress of the parturition. Rectal palpation proved that the calf was in backwards position. Unfortunately ultrasonography equipment was not available. The presence of the amniotic sac was visible as a bulging below the anus. Labour activities stopped at that point. Total serum calcium level was 2.44 mmol/l (in 1993 this was still wrongly considered within normal ranges). T he animal was chained and 50 IU of oxytocin s.c. to stimulate uterine contractions. T he calf could easily be pushed backwards in between contractions (which nowadays is considered a sign of hypocalcemia!). No reactions of the calf were felt during these manipulations. The animal responded well to oxytocin. The uterine contractions and labor activities intensified during the next 30 min, but no progress was made. Two hours after the dministration an i.v. infusion of 750 ml of Ca- Mg-borogluconate was administered, containing 12 g calciumborogluconate. Another 50 IU of oxytocin s.c. was given at the same time. As before, the induced labour activities did not result in progress of the parturition. Again 2 hours alter, 50 IU oxytocin was given slowly IV, resulting in strong labour activities. One arm was brought into the vaginal vestibulum and the amniotic sac was cut using a vinger knife and a rubber rumen tube was advanced through the vestibulum and the tip of the tube was placed between the feet of the calf. Through this tube approximately 2 L of a lubricant was brought into the birth canal. SURGERY Local anesthesia was performed at 1700 hr by administering 5 injections of 20 ml lidocaine 2% + noradrenaline intra-and subcutaneously in the midline of the perineum, starting 5 cm ventrally of the anus, with an interval of 10 cm. Epidural anesthesia was not used, but new insides have proven that this is an important method to reduce movement of the tail and decreases pain perception in the perineal region. The perineum was brushed with a povidone iodine soap (Betadine scrub, Dagra Pharma B.V., 1112 AX, NL). A 25 cm long incision was made in the midline, starting 5 cm below the anus. A rubber rumen tube that was inserted retrograde into the birth canal. The vestibulum wall was incised over this tube just below the anus. This incision was enlarged ventrally to a distance of 25 cm. The hind legs were not visible at that time and chains had to be fitted blindly. Parts of the thick amniotic sac had to be cut away for better attachment of the chains. No reaction from the calf was observed during these operations. The chains attached to the calf’s hind legs were initially passed through the distal part of the vulva in an attempt to pull the legs through the natural birth canal. Pulling the chains essentially horizontally caused too much irritation on the vulva, so this procedure was abandoned. The incision was then enlarged ventrally to 37 cm. Pulling at the chains by 4 people resulted in advancement of the legs throught the surgical opening. The legs presented in horizontal position next to each other but when the tarsus were outside the opening, the calf got stuck in the maternal pelvic cavity. Standing back to back, two persons pushed the calf as far as possible back into cranial direction of the birth canal. When accomplished, e ight people, four on each hind leg, were allowed to pull on the chains: by pulling on one leg at the time and changing the direction during 45 min, the calf was rotated 90° and could finally be extracted. During the extraction, it became evident that the umbilical cord was twisted twice around the hind legs, which had probably resulted in the death of the calf. It is well known from cattle and horse obestetry, that a dead fetus is often associated with dystocia, as the longitudinal rotation of a fetus is facilitated by movements of the fetus during its passage through the birth canal. TREATMENT of the SURGICAL WOUND The surgical wound was closed in 3 layers. The vestibulum wall was closed using atraumatic Dexon 0. A nonperforating continuous suture, tied after every fifth stitch was made. No subcutaneous tissue was available for suturing. The skin wound was flushed with 10% diluted povidone iodine. The endodermis was sutured using atraumatic Dexon 1 with the same type of stitch. The skin was closed with Mersilene 4 using 27 single stitches. The wound was sprayed with U.S.P. wound spray. Amoxicillin was given at 5 mg/kg i.m. SID for 4 days, when reatment was changed to enrofloxacin given at a dose of 1.33 mg/kg i.m. This treatment was continued until day 11 when the entire wound spontaneously opened. The wound was sutured again under local anesthesia and xylazine sedation on four occasions at 8-12 wk intervals. The first attempt was made 8 wk after the vestibulotomy. The animal was given 480 mg zuclopentixol p.o. 1 hour prior to surgery. This seemed to chang her behavior in an undesired way; she became more alert and aggressive than was expected. Granulation tissue was removed and the wound was closed in two layers, using the same material used for the initial sutures. The wound opened again within a week. The wound was cleaned again completely and the mucosa was separated from the underlying tissue. A nonperforating continuous stitch with thicker suture material, was used to close the wound; monofilamentous PDS-1 was used for the vestibulum, and braided PDS-1 for the submucosal/subcutaneous tissue. The skin was closed with a continuous mattress stitch with sheep’s Bühner tape using a modified Gerlach’s needle. Each skin perforation was made 2-3 cm from the incision and protected by 3 mm thick rubber rings (3 cm diameter). The animal remained hobbled on both hind legs during the following 10 days. During this period she received 500 mg acepromazine (Vetranquil granulate, Sanofi, 3144 EG, NL) p.o. b.i.d., 50 mg butorphanol p.o. b.i.d. and 20 g amoxicillin p.o. b.i.d. The wound opened partly after a few days. Twelve weeks later a third attempt was made to close the two remaining fistulas. Only the mucosa of these vestibulum fistulas (5 cm and 0.8 cm respectively) were closed in three layers, using PDS-1. Again these wounds opened after a few days. One more attempt was made to close the remaining fistulas, which were healing per secundum. A modified balloon catheter was inserted into the urethra during this intervention. The orificium urethrae could be reached by hand, just at the edge of the horizontal part of the birth canal. The balloon was filled with 50 ml of water. Only the vestibulum mucosa was stitched to reduce infection of the wound by accumulation of purulent material in the subcutaneous space. During the following 2 days all urine was passed through the catheter. On the third day, the urine passed through the wound again. The catheter has never been recovered. No more attempts to suture the wound were made. Treatment results In the following 1.5 year the wound healed per sucundam to date two fistulas of 10 mm and 2 mm respectively. Aspect of the wound immediately after closing the wall of the vaginal vestibulum Aspect of the wound 11 days after first attempt to close the wound. Immage of the sutured skin immediately after the second attempt to close the wound. Separating the wall of the vaginal vestibulum from the skin before suturing the vestibulum for the 3rd time. Immage of the wound 2 weeks after the second attempt to close the wound. The use of Bühner tape and rubber tubes to prevent the skin sutures from cutting into the skin during the 3rd attempt to close the wound. COMMENT of the AUTHOR Closing the wound after a vaginal vestibulotomy does not seem to be rewarding. The wound healing capacity of the elephant skin is enormous. To my knowledge, in all reported cases the skin sutures did not hold and the skin wound finally closed per secundam ( Miller et al. 2004 ). Closing the vaginal vestibulum might be worth attempting, as it may result in partial or complete healing of the vestibulum wound (Thitaram et al. 2006). Nevertheless, leaving the entire wound open will finally result in excellent healing per secundam. However, the epithelium of the vaginal vestibulum may fuse before the skin wound is closed. This condition requires minor surgical intervention, by separating the 2 layers and dissecting a small strip of the edges. See also the case report of the fetotomy . References Schaftenaar, W. 1996. Vaginal vestibulotomy in an Asian elephant (Elephas maximus ). Proceedings Am. Ass. Zoo Vet. 434-439. Chandrapuria, V.P., Shrivastava A. B., Agrawal S, and Agarwal S. 2014. Vaginal Vestibulotomy in an Asian Elephant. Gajah 40 (2014) 39-41 Merckt et al. 1985. Episiotomy, a possible obstetrical intervention in the elephant cow. Dtsch Tierarztl Wochenschr, 1985 Oct 8;92(10):428-32. Miller M., Neiffer D., Schmitt D., Weber M., Robbins P.K., Stetter M., Fontenot D., Fleming G., Miller G., and Maluy P. 2004 Medical management of dystocia and vestibulotomy for removal of a retained fetus in an African elephant. In: International elephant Research Symposium, Fort Worth (Texas) organized by The International Elephant Foundation. Pg 14-17. Thitaram C. et al. 2006. Dystocia following prolonged retention of a dead fetus in an Asian elephant (Elephas maximus ). Theriogenology 66,1284–1291. EAZA Veterinary guidelines for reproduction-related management in captive female elephants. 2020 . EAZA reproduction guidelines To page top

The hormonal changes (progesterone, estrogen and luteinising hormone (LH) play a key role in the estrous cycle. Transrectal ultrasound examination can visualize the ovaries, uterus and (vestibular) vagina. Monitoring the estrous cycle is done with gestagen assays in blood (ADVIA Centaur XP or miniVidas), urine (beta-pregnanetriol) or feces (usually locally designed assays). To reproduction Estrous cycle Schematic overview of the endocrine and ovarian events during the estrous cycle (courtesy Imke Lüders). LUF= Luteinizing follicles LH = Luteinizing Hormone Pm = Progestagens CL = Corpus Luteum ovCL = CL from ovulation acCLs = accessory corpora lutea Progestagens in elephants include a large group of progesterone-like molecules. The major part of progestagens found in the blood of elephants does not react in the usual human assays. When starting monitoring progestagens, one should always validate first the assay by providing serum samples with known progestagen concentrations of different levels. Even the use of the same hardware, is not always a guarantee that the results are reliable. Companies permanently develop news progesterone assays for the same machine, which are more specific for human progestagens and less for elephant progestagens. The estrous cycle can be divided in 2 major phases, the luteal phase and the non-luteal or follicular phase . The luteal phase starts after ovulation and lasts on average 10 weeks. It is characterized by elevated progestagen blood levels. The follicular phase starts when the progestagen blood concentration has dropped to what we call in this document the “base line” value. Progesterone serum levels in mmol/l during the estrous cycle in an elephant. Note the 2 LH-peaks (red arrows). Progesterone analysis Many lab assays fail to accurately measure progestagens in the blood during the follicular phase in elephants. Some machines calculate these low concentrations rather then measuring them exactly. Moreover, the progestagen concentrations that are provided by the different laboratories, vary greatly depend on the machine and technique used. It is therefore very important to use the same technique and machine for monitoring the estrous cycle of an individual elephant. Note: progestagen concentrations measured by one assay may differ up to a factor 10 from the results obtained when another assay is used. Automated analysers that have proven to give reliable results for both species are: ADVIA Centaur XP (Siemens) with ranges between 0.21 mmol/l and 10 mmol/l. miniVidas (Biomérieux) with ranges between 0.79 mmol/l and 15 mmol/l. Laboratory System canine progesterone assay: point-of care (=on the spot) assay to measure 4-pregnen-3,20-dione drop as prediction for parturition (Molenaar et al. 2022). During the follicular phase, approximately 18-20 days prior to ovulation, a 1-day LH-peak concentration can be distinguished, which may result in a temporary rise of progesterone. This first LH-peak results in ovarian follicles that will not ovulate. These follicles produce progesterone untill they go into gregression in the luteal phase. A second LH-peak occurs just prior to ovulation. This LH-peak induced ovulation in one follicle. The remaining corpus luteum will also produce progesterone and maintain the luteal phase for about 10 weeks. To monitor the estrous cycle in elephants gestagens can be measured in blood (progesterone), urine (pregnanetriols, Primate Center Göttingen, Germany) or feces (progesterone, Chester Zoo, UK). Frequency of sampling should be once a week for blood and urine and 3 times per week for feces. Urine samples Urinary hormone analyses are performed at the Endocrinology Lab at the German Primate Centre in Goettingen, Germany. All facilities in Europe are welcome to send samples on a voluntary basis and assays are run every week. The service for the Asian elephants started in 1994 and that for African elephants in 1996, so comparative data are available for more than 20 years. It is important to note that in urine not progesterone itself but its metabolites are measured. These metabolites differ between the two elephant species. Whilst in Asian elephants pregnanetriol (P3) is the most abundant metabolite in urine, it is 5α-pregnane-3-ol-20–one (5α-P-3-OH) in African elephants. This means that different assays are needed for Asian and African elephants. The pregnanetriol concentration in the urine is always compared with urinary creatinine. If the creatinine level is too low, a new sample should be submitted. Urine can be collected in many different ways depending on keeping and housing system. Elephants can be trained to urinate on command. Only 2 ml urine are needed for the analysis. It is good to use plastic tubes that close well, best with screw lid. Labelling of the sample is essential! Labels must be waterproof and show the name of animal and the date of collection. If the samples are not sent within 2 days after collection, they need to be frozen soon after collection. See also the Practical guide for urine collection (Ann-Kathrin Oerke) . Fecal samples The estrous cycle can also be monitored by measuring gestagens in fecal samples (3 samples per week). Currently Chester zoo offers this service. If you are interested in this method of monitoring the estrous cycle, please contact Sue Walker (s.walker@chesterzoo.org) or Rebecca Mogey (r.mogey@chesterzoo.org). References Molenaar FM, Rowcliffe M, and Lakey A. 2022. Adaptation of a point-of-care canine progesterone test for use of parturition prediction in captive Asian elephants (Elephas maximus): proof of concept. J. of Zoo & Wildl. Med. 53(4): 791–796, 2022. Practical guide for urine collection (Ann-Kathrin Oerke) . Veterinary guidelines for reproduction-related management in captive female elephants . EAZA 2020. To page top

The morphology of elephant blood cells is described and demonstrated by photos. To hematology Hematology gallery Compiled by: Willem Schaftenaar and Fieke Molenaar On this page we give examples of normal blood cells stained with Wright-Giemsa. An excellent description of normal and abnormal white blood cells in elephants was published by Stasi et al in 2017. Click here to read that article. Morphology of blood cells, stained with Wright-Giemsa Wright-Giemsa stained blood smear of a healthy adult Asian elephant displaying normal erythrocytes, 1 heterophil, 1 bi-lobed monocyte and several thrombocytes (Courtesy: Rotterdam Zoo). Wright-Giemsa stained blood smear of a healthy adult Asian elephant displaying normal erythrocytes, 1 bi-lobed monocyte, 1 lymphocyte and several thrombocytes (Courtesy: Rotterdam Zoo). The images below were published in the Proceedings of the Zoo and Wildlife Health Conference 2020, 23-31: Molenaar F.M. 2020. Developing haematology skills to enable decision making in suspected cases of Elephant Endotheliotropic Herpesvirus hemorrhagic disease. Heterophil (H), single lobed and bi-lobed monocytes (M), lymphocyte (L). The arrows pont at platelets (Courtesy: Fieke Molenaar). Immature heterophils: bands (Courtesy: Fieke Molenaar). Eosinophil (Courtesy: Fieke Molenaar). Lymphocyte (Courtesy: Fieke Molenaar). Immature lymphocyte (Courtesy: Fieke Molenaar). Monocyte (Courtesy: Fieke Molenaar). Monocytes (Courtesy: Fieke Molenaar). Immature monocytes (Courtesy: Fieke Molenaar). Lymphocyte and 2 monocytes (Courtesy: Fieke Molenaar). Platelets (arrows) (Courtesy: Fieke Molenaar). Erythrocytes: "codocytes" (target cells with a bulls-eye appearance) occur naturally in elephants (Courtesy: Fieke Molenaar). Fragmented erythrocytes Fragments of erythrocytes (schistocytes) as can be seen in elephants suffering of Disseminated Intravascular Coagulation (e.g. EEHV-HD) (Courtesy: Fieke Molenaar). To page top

A variety of clinical procedures are described here: anesthesia, standing sedation, necropsy, broncho-alveolar lage, trunk wash, body condition score, serum banking, monitoring estrous cycle, pedicure, plasma transfusion, tusk repair, injection technique. Blood collection Hand-rasing Fecal quality control Foot care - curative Foot Care - regular Necropsy procedure Plasma transfusion Surgery Trunk wash procedure Tusk repair procedure Clinical Procedures Anesthesia Banking serum Body condition score Broncho-alveolar & Gastric lavage Injection techniques Monitoring estrous cycle Procedures