When does the physical exam begin? The exam starts the moment the patient is presented to you. If possible have owners bring smaller birds (parakeet, finch, canary, etc.) in their permanent home cages, this will allow you a look at how the family maintains the cage.
Take your time to observe the patient prior to physically touching the patient. We know that most birds will not be as relaxed as if they were at home but there is still a lot to learn from observing them for a few minutes. Take note of their behavior, their interaction with you as you speak to them, where they like to be in their cage and their general attitude. Take a close look at the condition of the cage, toys, water and food bowls, treats, droppings, perches, cleanliness, substrate at bottom of cage, size of cage, etc.
The only way to perform a proper physical examination on avian patients is to pick them up. Larger birds need to be wrapped securely but safely in a towel, as well as some of our smaller mouthy birds. Performing a physical in the same manner every time will ensure that you do not miss anything. Before we discuss how to perform a physical examination we need to discuss some of the reasons NOT to pick up a bird for an examination or when to quickly PUT HIM DOWN on the table or in their cage.
- Any time a bird is panting or breathing rapidly this may be a warning sign of distress. Quickly reposition your grip. The bird should turn its head and try to bite the towel; if the panting does not stop PUT HIM DOWN.
- Some good birds will lie still in a towel, most DO NOT. If the bird seems to be cooperating and not moving place the corner of the towel near his mouth. If the bird DOES NOT grab onto it he is most likely weak. PUT HIM DOWN.
- If the bird closes his eyes, PUT HIM DOWN. Keep in mind not all birds close their eyes if they are in distress.
- Allow the bird to grasp your finger with its feet. If he is presented for a broken leg or neurologic problems a foot grasp may not happen. During a routine examination if the grasp is weak or nonexistent PUT HIM DOWN.
- With avian patients if at any time during the examination you have ANY doubt if the patient is in distress PUT HIM DOWN.
Physical Examination
Observation: Birds more than any animal tend to hide signs of illness. Hiding their illness comes from the flock mentality; if they show signs of illness in the wild they will open themselves up to predators. When they no longer can compensate for their illness it will then be known to others. A well bird in an office call should NOT be fluffed up, closing their eyes, “tail bob”, or sitting at the bottom of the cage.
Weight: Avian patients MUST be weighed at every visit. The only way to get an accurate weight is to use a gram scale. For friendly birds you can use a perch stand on top of the scale and for others a small basket/cage on the scale. Always zero the scale with the perch or cage on it. It is a good idea for families to purchase a scale and weigh their bird on a weekly schedule.
Feathers: The quality of feathers is the first thing we take note of. Is there feather loss, abnormal molting, ectoparasites, damage, stress bars or abnormal coloring? The preen gland is located on the dorsal midline of the tail feathers and needs to be examined for symmetry, inflammation or bleeding.
Skin: Parting the feathers in several places, closely examine the skin for flaking, redness, blood, pitting of the surface, inflammation or masses.
Head: Look for symmetry, inflammation or bruising.
Eyes: Look for symmetry, discharge or opaque lens. Use an ophthalmoscope for a through exam.
Beak: Look for symmetry, abnormal wear, severe flaking, pitting on the surface or fractures.
Nares: There is a normal structure just inside the nares called the operculum; you should NOT disturb this structure. Examine the nares for discharge, blockage, blood, inflammation or any masses.
Ears: There should be no inflammation, odor or discharge.
Oral Cavity/Mouth: If necessary use a beak speculum for the examination. There should be no abscesses, plaques or necrotic tissue. The glottis is located at the base of the tongue and should also be free of abscesses or epithelial plaques. The choanal slit is lined with epithelial projections called papilla. Inflamed choanal slit or lack of papilla can indicate upper respiratory infection.
Crop: Crop burns, bruising or necrosis may be seen in birds that are being hand raised and are being syringe fed with food that is too hot. Foreign bodies are not common but can occur. Crop stasis or large doughy feeling crops due to undigested food can be a sign of a bacterial ingluvitis.
Keel Bone and Pectoral Muscle: The edge of the keel should be able to be palpated between the rounded pectoral muscles that slope slightly to either side. If the keel bone is prominent the bird is considered underweight. Both underweight and overweight can be life threatening.
Wings: Carefully check range of motion and joint integrity. Look for blood feathers, broken or missing feathers, fractures or dislocations of wings, masses, ulcers or ectoparasites.
Cloaca: Observe the area for cleanliness, no accumulation of feces, no sign of dilation or prolapse of tissue, and no masses.
Feet/Legs: Look for symmetry and check range of motion. Plantar erosion can be noted as pink areas at the bottom of the feet. Also check for scaly skin, ulcers, scabs, inflammation, gout, or necrotic tissue. Be sure the length of the nails is a good length for the species of bird you are examining and trim if necessary. Have the bird hold onto your finger and see how well he can grasp on.
Abdomen: The caudal area of the bird is difficult to examine due to the keel bone. At times you may only be able to use a single finger to palpate underneath the keel bone. At this point check for tumors, eggs, hepatomegly or ascities.
Hydration Status: In a normal hydrated bird, the basilic vein should instantaneously refill by the time you take your finger off the vein. If the basilic vein can be seen to refill, then it is estimated the bird is approximately 5% dehydrated. If the vein requires one second to refill, then the bird is severely dehydrated or is in shock.
References:
Exotic Animal Care – Tully and Mitchell
Exotic Animal Medicine for the Veterinary Technician – Ballard and Cheek
