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==Description==

==Description==

'''Protein-losing enteropathy (PLE)''' can result from any intestinal disease which produces sufficienct inflammation, congestion or bleeding.  This causes protein to leak into the intestines, which exceeds the gut lumen protein synthesis.  Hence, there are numerous causes of PLE, for example lymphangiectasia, infectious, structural, neoplasia, inflammation, endoparasites and gastrointestinal haemorrhage.   

'''Protein-losing enteropathy (PLE)''' can result from any intestinal disease which produces sufficient inflammation, congestion or bleeding.  This causes protein to leak into the intestines, which exceeds capacity of the gut lumen protein synthesis.  Hence, there are numerous causes of PLE, including lymphangiectasia, infectious causes, structural causes, neoplasia, inflammation, endoparasites and gastrointestinal haemorrhage.   

The major causes of PLE in adult dogs are inflammatory bowel disease (IBD), alimentary tract lymphoma, fungal infections (e.g. histoplasmosis).  Other causes include ulcerations or erosions, severe disease of intestinal crypts and parasites.  The most common causes in very young dogs are hookworms and chronic intussusception.  Chronic intussusception results from acute enteritis which had not resolved completely, with some clinical improvement but continuation of diarrhoea.  PLE is less common in cats than dogs, and most often caused by alimentary tract lymphoma and IBD.  Cats almost never suffer from lymphangiectasia, and rarely have severe parasitic infection severe enough to cause PLE.  Non-intestinal diseases which can be associated with PLE include congestive heart failure, caval obstruction and portal hypertension.  However, these animals usually present with ascites rather than diarrhoea.

The major causes of PLE in adult dogs are inflammatory bowel disease (IBD), alimentary tract lymphoma, fungal infections (e.g. histoplasmosis).  Other causes include ulcerations or erosions, severe disease of intestinal crypts and parasites.  The most common causes in very young dogs are hookworms and chronic intussusception.  Chronic intussusception results from acute enteritis which has not resolved completely.  The animal shows some clinical improvement but diarrhoea still continues.  PLE is less common in cats than dogs, and most often caused by alimentary tract lymphoma and IBD.  Cats almost never suffer from lymphangiectasia, and rarely have severe parasitic infection severe enough to cause PLE.  Non-intestinal diseases can be associated with PLE include congestive heart failure, caval obstruction and portal hypertension.  However, these animals usually present with ascites rather than diarrhoea.

====Haematology====

====Haematology====

*Panhypoproteinaemia

*Panhypoproteinaemia

**Hepatic insufficiency and protein-losing nephropathy should also be pursued in hypoalbuminaemia.

**Hepatic insufficiency and protein-losing nephropathy should also be pursued with hypoalbuminaemia.

*Lymphopaenia

*Lymphopaenia

===Diagnostic Imaging===

===Diagnostic Imaging===

====Radiography====

====Radiography====

*Abdominal radigraps are usually unremarkable.

*Abdominal radiographs are usually unremarkable.

*Thoracic radiographs may show pleural effusion, metastatic neoplasia or eveidence of histoplasmosis.

*Thoracic radiographs may show pleural effusion, metastatic neoplasia or eveidence of histoplasmosis.

===Histopathology===

===Histopathology===

*Endoscopically guided multiple biopsies are useful.  However, surgical biopsy may be required for a definitive diagnosis of lymphoma and secondary lymphangiectasia.  A small fatty meal could be given the night before biopsy to increase the chance of diagnosing lymphangiectasia.

*Endoscopically-guided multiple biopsies are useful.  Surgical biopsy may be required for a definitive diagnosis of lymphoma and secondary lymphangiectasia.  A small fatty meal could be given the night before biopsy to increase the chance of diagnosing lymphangiectasia.

==Treatment==

==Treatment==

===Plasma transfusion===

===Plasma transfusion===

*This may be used to increase plasma volume perioperatively.  However, much of the albumin is lost in the gut and a substantial amount does not remain in the intravascular compartment.  Therefore, plasma transfusion is unable to increase the serum albumin level by much.

*This may be used to increase plasma volume.  However, much of the albumin is lost in the gut and a substantial amount fails to remain in the intravascular compartment.  Therefore, the extent of increase in serum albumin level is not great.

*Administration of colloid may be more suitable if it is necessary to increase the plasma oncotic pressure.

*Administration of colloid may be more suitable if it is essential to increase the plasma oncotic pressure.

===Diuretics===

===Diuretics===

*This can be used to reduce ascites

*This can be used to reduce ascites.

*Spironolactone 1-2 mg/kg PO BID may be more effective than frusemide.

*Spironolactone 1-2 mg/kg PO BID may be more effective than frusemide.

==Prognosis==

==Prognosis==

 

==References==

==References==

*Ettinger, S.J. and Feldman, E. C. (2000) '''Textbook of Veterinary Internal Medicine Diseases of the Dog and Cat Volume 2''' (Fifth Edition) ''W.B. Saunders Company''.

*Ettinger, S.J. and Feldman, E. C. (2000) '''Textbook of Veterinary Internal Medicine Diseases of the Dog and Cat Volume 2''' (Fifth Edition) ''W.B. Saunders Company''.

*Hall, E.J, Simpson, J.W. and Williams, D.A. (2005) '''BSAVA Manual of Canine and Feline Gastroenterology (2nd Edition)''' ''BSAVA''

*Hall, E.J, Simpson, J.W. and Williams, D.A. (2005) '''BSAVA Manual of Canine and Feline Gastroenterology (2nd Edition)''' ''BSAVA''.

*Nelson, R.W. and Couto, C.G. (2009) '''Small Animal Internal Medicine (Fourth Edition)''' ''Mosby Elsevier''.

*Nelson, R.W. and Couto, C.G. (2009) '''Small Animal Internal Medicine (Fourth Edition)''' ''Mosby Elsevier''.

*Willard, M. (2005) '''Protein-Losing Enteropathy in Dogs and Cats''' ''30th World Congress of the WSAVA''

*Willard, M. (2005) '''Protein-Losing Enteropathy in Dogs and Cats''' ''30th World Congress of the WSAVA''.