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The Avian Physical Examination

Peter S. Sakas DVM,MS
Niles Animal Hospital and Bird Medical Center
7278 N. Milwaukee Ave. Niles, IL 60714
PH (847)-647-9325 FAX 847-647-8498
Niles Animal Hospital & Bird Medical Center

Physical Examination

The following discussion covers what is evaluated during a proper 'hands on' physical examination by an avian
veterinarian. Hopefully, it will enable you to better evaluate your birds, as well as understand what your veterinarian
is looking at during the examination. There are many variations of performing the exam but
I prefer to start with the head and work downward.

1) Head - I initially begin by evaluating the feathers on the head, looking for normal feather development and good
quality feathers. If there are bare patches or poor feather development nutritional, metabolic or systemic disease may
be responsible. Trauma could cause feather loss. If the feathers are being plucked on the head, you can determine
this by the presence of black stumps where blood feathers were picked, which would indicate domination by another
bird in the cage/household. Abnormal crest feathers on cockatoos may sometimes be the first indication of Psittacine
Beak and Feather Disease. The skin is paper thin and will be slightly flaky. Excessive flakiness could indicate a
nutritional condition such as a vitamin A deficiency.

2) Cere/Nares - The cere and nares are then evaluated. The cere is usually dry and may be slightly flaky. There
should be no unusual swellings noted. The color of the cere is used to determine sex in budgies: blue in males, light
blue or brown to dark brown in females. Unfortunately this is not always reliable especially with the color mutations
and it also varies with age. A female in breeding condition may undergo brown hypertrophy of the cere and in severe
cases may occlude the nares. It can also be seen in males with testicular tumors that secrete estrogen.
The nares should be symmetrically placed in the cere and similar in size and shape. The nostrils should be open with
no discharge noted. As mentioned earlier sometimes discharge may be seen only as staining above the feathers
indicating rhinitis. In some instances thick, flowing discharges may be noted.
On occasion the nostrils are blocked and removal of the plug will free the discharge.
Very enlarged nostrils may have been the result of chronic rhinitis or injury.
Chronic nasal discharge may produce grooves in the beak.

3) Beak - The beak should be relatively smooth and clean. A small degree of flakiness is normal, if the bird is a poor
chewer the beak may appear rough as the older beak does not wear away with beak usage. Excessive flakiness of the
beak or dullness could indicate a nutritional problem.
For reasons not yet determined, in fatty liver disease the beak will grow abnormally rapidly and irregularly.
Particularly in parakeets and some cockatiels with fatty liver disease there may be black/brown areas of hemorrhage
on the beak and toenails coupled with some deterioration of the beak. These birds should be handled with extreme
caution as their systems are extremely compromised.
Malocclusions are frequently noted, particularly twisting of the upper beak. The causes are uncertain but heredity,
trauma, malnutrition or systemic disease have been implicated. Such conditions can be treated surgically or with
frequent beak trimming so the beak can remain functional.

4) Mouth - Examination of the mouth is a very important part of the physical. The beak can be held open with a
speculum, scissors, gauze strips, etc. and a direct light source should be used to illuminate the oral cavity.
Care must be taken with birds that have thin margins of the beak, such as macaws and cockatoos for if they bite down
aggressively cracking of the beak and hemorrhage may occur.
The epithelium of the oral cavity should be smooth. In bacterial infections it may appear to have a grayish cast,
sometimes with a pungent odor. Off-white oral lesions may be seen, usually due to squamous metaplasia produced
by a vitamin A deficiency (one of the most common nutritional deficiencies seen). Other causes of mouth lesions
include candidiasis, trichomoniasis, avian pox or bacterial infections. Candidiasis is especially common in young
birds being hand raised. Occasionally abscesses may be seen, particularly on the sides of the tongue.
The margin of the choanal slit should be sharp, clean and bordered by numerous sharp papillae. Blunted, absent
papillae, thickened edges to the choanae and white plaques indicate vitamin A deficiency. This can provide ample
opportunity for secondary pathogen invasion. Choanal viral papillomas may also be noted in Amazons, macaws and
particularly hawk headed conures. Occasionally these papillomas may be peppered throughout the oral cavity and
have been noted in close proximity to the glottis interfering with respiration.

5) Eyes - The eyes of the bird should be examined as any other animal, however, an added feature is that birds have
a functional third eyelid. Check for any abnormalities of the margins of the eyelids. Avian pox can cause deformation
of the eyelids as well as corneal ulcerations, particularly in blue fronted Amazons. Discharges, conjunctivitis,
matting of feathers around the eyes, and periophthalmic swellings are all indications of infections. Mycoplasma may
cause these signs in cockatiels and budgies.

6) Ear - Ear infections are uncommon in birds but they do occur. In my experience I most often see otitis externa in
lovebirds. Discharge may be noted and the ear canal swollen shut. On occasion pruritus (itchiness) in the region may
lead to self-mutilation.

7) Neck/Trachea - Leaving the head, the neck and trachea are palpated for any unusual swellings or abnormalities.
In small birds such as canaries and finches the feathers in the neck can be wetted and the trachea transilluminated to
detect air sac mites.

8) Crop -The crop should be palpated next. Palpate the crop contents -is there fluid, food, masses, gas, foreign
body? Care must be taken if there is fluid in the crop to prevent backflow into the mouth and aspiration. The crop
wall should feel relatively thin, in some cases of candidiasis, particularly in young birds, a thickened crop can be
palpated. Hand raised birds fed formulas that were too hot could suffer from burning of the crop with resultant
fistulation. This can be detected when food runs through the fistula during feeding, visualizing the actual fistula,
scabbing, or the presence of food on the lower aspect of the crop.

9) Chest - The pectoral muscles and keelbone should be palpated/evaluated. Over time you will develop a feel for
the normal muscle mass of the chest. Birds that are ill can lose weight rapidly and this is manifested by the loss of
musculature, in fact this may be one of the initial signs of a disease condition before serious clinical signs are noted.
Sick birds will tend to ruffle their feathers which would mask the loss of musculature, hence the client or the
veterinarian would not be aware of the loss unless the bird was actually handled/palpated. Obesity in birds could also
be detected as fat deposits/lipogranulomas may develop on the chest/abdomen. Palpation of the pectoral muscles
should not serve as the only means of evaluating a bird's weight/condition. An important part of every physical
examination is to obtain the weight of every bird and record it so comparisons can be made. Dehydration can be
detected with skin fold elasticity as in other animals. I have noted that in dehydrated birds their skin appears dark
with little elasticity; almost tight on their face/trunk.

10) Abdomen - The abdomen of the bird is quite small, the cranial border at the base of the sternum running
caudally to the pelvis. It is normally palpable as a slight indentation and in the normal bird very little is discernible
on palpation. On occasion the gizzard can be detected as a firm mass on the left side of the abdomen and could be
mistaken as a growth. Liver enlargements can be determined through the palpation of the right lobe of the liver,
protruding beyond the margin of the sternum; normally it is not palpable. Neoplasms and eggs may be detected
through abdominal palpation. In a bird that is undergoing reproductive activity, the abdomen may enlarge due to the
enlargement of the uterus.
A grossly enlarged abdomen could indicate a reproductive tract disorder (egg-binding, cystic ovaries, etc.),
neoplasms, obesity, and ascites (secondary to heart disease, neoplasms, and reproductive tract disorders). Care must
be taken in handling these birds as their respirations are compromised due to abdominal enlargement. Rough
palpation could rupture the abdominal air sacs and cause death.

11) Vent - The vent should appear clean and unsoiled. Staining of the vent with droppings indicate a gastrointestinal
disturbance such as diarrhea or the presence of an abdominal mass irritating the gut, interfering with normal passage
of droppings. Cloacal prolapse, egg binding or cloacal papillomas can also produce staining. An enlarged, dilated
vent may indicate hormonal stimulation in the female bird and reproductive readiness.

12) Feet/Legs - The feet/legs have scales similar to reptilian skin and it appears smooth/shining.
Check the bottom of the feet for pressure sores/ ulcerations commonly caused by improper perches or malnutrition.
Hyperkeratosis of the feet may occur due to hypovitaminosis A.
Crustiness of the feet/legs, particularly in small birds (budgies/ canaries) may serve to indicate cnemidocoptic mange (scaly leg/ face).
Check the leg/joints for any structural abnormalities.

13) Wings - Examine the wing/joints very carefully. Check range of movement and for evidence of old
injuries/fractures. Evaluate the web of the wing for presence of an India ink tattoo, especially in the larger birds.
In birds that are surgically sexed the males are marked in the right web , females on the left.
Scrutinize the feather quality on the wing (and the entire body as you go along);
checking for the presence of abnormal feathers, discolorations, stress lines and, in wild caught birds, parasites (mites/lice).
Check the feather shafts on new imports as occasionally feather follicle mites may be seen.
The feather shaft should normally be clear, if feather follicle mites are present the feather would be filled with brownish debris.
Confirm the diagnosis by opening the shaft and examine the contents microscopically, when you would see exoskeletons of the mites.

14) Auscultation - Auscultations can be beneficial.
For best results a pediatric stethoscope should be used.
The heart is difficult to evaluate due to its rapid rate. Respiratory abnormalities can be detected readily.


By tying together the aspects of a thorough physical examination, examination of the cage/contents,
examination of the bird in the cage, proper capture/restraint and a systematic hands on exam,
a significant amount of information as to the state of the bird's health can be gained.
However, this is still not complete as the physical should be complemented with minimally a CBC, fecal exam and mouth swab.
Cultures, chemistries and radiographs may also be performed for the complete physical. Birds hide their illnesses
effectively so an external exam alone is inadequate.
Thus by combining an external examination and appropriate diagnostic tests we can generate an excellent evaluation of a bird's health.

Adapted from Essentials of Avian Medicine: A Guide for Practitioners, Second Edition by Peter S. Sakas, DVM,
MS. Published by the American Animal Hospital Association Press. (2002)
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