Another  common reason that snakes are brought to veterinarians for exams is  that they are regurgitating or vomiting. Regurgitation occurs soon after  eating, whereas vomiting occurs hours or days after ingestion of food.  Regurgitated food is generally undigested food expelled primarily from  the esophagus (passively, that is, without much force). Uomitus consists  of partially digested food, usually actively expelled from the stomach.  With reptiles, distinguishing between the two actions can sometimes be  difficult. The point is that the snake is not holding down food, and  possible causes are numerous.- Handling too much or too soon after feeding
 - A sharp (sudden) drop or rise in ambient temperature or just improper ambient temperature for digestion
 - Increased stress (including from mating) soon after feeding
 - A meal that is too large, too old, or too toxic or offered too frequently
 - Bacterial infection
 - Protozoal infection (amoeba, coccidian, flagellate)
 - Metazoan (worm) infection
 - Tumor
 - Excessive drinking right after eating
 - Dehydration
 
Sometimes, making minor changes to a snake's environment or  adding a new animal to the enclosure may be very stressful for the snake  and cause it to vomit its last meal. Perhaps the most common cause of  vomiting or regurgitation is an ambient temperature that does not allow  normal digestion. More frequently, a drop in ambient temperature is the  cause of sudden onsets of vomiting or regurgitation, yet it also can be  caused by sharp rises in temperature. This symptom should serve as a  warning to the herpetoculturist that the normal ambient temperature may  be marginal for digestion.
Very large meals may cause irritation of the gastrointestinal  tract and may result in vomiting or regurgitation. Toofrequent feedings  have the same effect. In snakes, irritation leading to vomiting or  regurgitation may also be the result of swallowing a large meal  backward; the scales of a fish or the fur of a mammal—which generally  are directed from nose to tail—would be pushed up if the prey were  swallowed tail end first and would irritate the snake's insides.
If the prey offered has been in freezer storage for a  long time, perhaps longer than six months, it may be loaded with  bacteria or bacterial toxins, which in some cases may induce vomiting or  regurgitation as happens with humans in cases of food poisoning. Some  food items, such as certain species of frogs and toads, produce chemical  toxins that may be a little more than some snakes can handle.
Bacteria flourish in a filthy environment. Bacteria that are  extremely contagious are commonly discovered as the cause of outbreaks  of vomiting. These bacteria may be responsible for an inflammation of  the lining of the stomach and intestine known as bacterial  gastroenteritis. Not surprisingly, two of the contagious gram-negative  bacteria, Salmonella and Arizona, are frequent offenders. These  bacterial infections are among the few cases in snake medicine in which  oral antibiotics are deemed appropriate and necessary. Ross and Marzec  (1984) and Ross and Maxzec (1990) have used ciprofloxacin and  amoxicillin successfully. The senior author of this book commonly uses  ciprofloxacin and enrofloxacin orally in snakes with gastroenteritis, at  the doses listed in the drug tables at the back of the book, and it has  worked very well.
Since we discuss parasites (protozoan and metazoan) in some  detail in the last chapter, we will not dwell upon them here. However,  you should always consult your veterinarian if you suspect parasites. It  is usually a waste of time and money—not to mention dangerous for the  snake—to pump one routine deworming agent after another into a  debilitated snake without the benefit of repeated fecal exams or a  gastric wash.
A foreign-body obstruction commonly occurs in captive snakes  that are housed on the improper substrate. Check your references, and  use the proper substrates as mentioned in chapter 2. Towels, hand  cloths, and T-shirts are not acceptable; they may be accidentally  ingested. Incidentally, you can sometimes induce the vomiting of an  ingested towel or hand cloth by lowering the cage temperature. Give the  snake a sterile electrolyte solution intraperitoneally to counteract the  dehydrating action of the towel. Then place the snake in a relatively  cool area, about 50°F to 60°F (10°C to 16°C). Vomiting of these soft  objects usually occurs within two to three days under these  circumstances. You must monitor the snake for dehydration, and  intraperitoneal fluids and antibiotics are advisable during and after  this procedure. Note that this is a practical field approach to be used  when sedation and endoscopic retrieval of the hand cloth are not  possible. This approach is definitely worth considering before  attempting surgical retrieval, but you must carefully monitor the state  of hydration in these animals. (In a seriously dehydrated snake, its  skin has wrinkles that return very slowly or not at all to their  original position when gently pulled away from the body)
In older snakes, tumors are definitely a possible cause of  regurgitation or vomiting. Your reptileoriented veterinarian can  determine if one is present by means of physical examination, endoscopic  exam, X ray, or any combination of these.
Many snakes tend to drink heavily after gorging on a large  meal. Sometimes, it appears that they may overdrink; vomiting or  regurgitation occurs soon afterward.
Dehydration theoretically causes irritation to the lining of  the gut by blocking the smooth passage of food because of the increased  friction, thereby increasing the likelihood of vomiting or  regurgitation.
When vomiting occurs, isolate the animal, restrict handling,  lower the temperature of the enclosure as needed, feed less frequently  and offer smaller prey, and make sure that the cage is clean and the  food is fresh. If vomiting persists, have your snake examined by a  reptile-oriented veterinarian, who may suggest a fecal exam, a culture  and sensitivity test, or a biopsy to determine the cause or causes of  the problem and the proper treatment.
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