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==Description==
'''Protein-losing enteropathy (PLE)''' can result from any intestinal disease which produces sufficient [[Inflammation - Pathology|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|lymphangiectasia]], infectious causes, structural causes, neoplasia, [[Inflammation - Pathology|inflammation]], endoparasites and gastrointestinal [[Haemorrhage - Pathology|haemorrhage]].
The major causes of PLE in adult dogs are [[Inflammatory Bowel Disease|inflammatory bowel disease (IBD)]], alimentary tract lymphoma, fungal infections (e.g. [[Systemic Mycoses #Histoplasmosis|histoplasmosis]]). Other causes include ulcerations or erosions, severe disease of intestinal crypts and parasites. The most common causes in very young dogs are [[Uncinaria stenocephala|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|lymphangiectasia]], and rarely have severe parasitic infection severe enough to cause PLE. Non-intestinal diseases can be associated with PLE include ][[Heart Failure - Pathophysiology|congestive heart failure]], caval obstruction and portal hypertension. However, these animals usually present with ascites rather than [[Diarrhoea|diarrhoea]].
==Signalment==
==Signalment==
The following breeds of dog may be afflicted:
*Basenji
*Basenji
*Lundehund
*Lundehund
*Soft-Coated Wheaten Terrier
*Soft-Coated Wheaten Terrier
**May have concurrent [[Protein Losing Nephropathy|protein-losing nephropathy]]
**Related to chronic granulomatous lymphangitis and enteritis
**Most affected animals have a common ancestor
**Females are more commonly affected that males
*Yorkshire Terrier
*Yorkshire Terrier
*Shar Pei
*Shar Pei
Image:Yorkshire_Terrier.jpg|'''Yorkshire Terrier'''<p>WikiCommons
Image:Yorkshire_Terrier.jpg|'''Yorkshire Terrier'''<p>WikiCommons
</gallery>
</gallery>
==Diagnosis==
==Diagnosis==
===Clinical Signs===
===Clinical Signs===
*Weight loss (predominant feature)
*Weight loss (predominant feature).
*Vomiting and diarrhoea ± melena
*Vomiting and diarrhoea ± melaena.
*[[Oedema - Pathology|Oedema]], ascites and pleural effusion
*[[Oedema - Pathology|Oedema]], ascites and pleural effusion due to reduced plasma oncotic pressure.
*Thickened intestines
*Thickened intestines related to the pathological process.
*[[Thromboembolism|Thromboembolic]] disease if procoagulants predominant due to loss of anticoagulant
*[[Thromboembolism|Thromboembolic]] disease due to the loss of anticoagulants such as antithrombin III.
*Hypocalcaemic tetany due to a reduced ability to absorb [[Vitamin D|vitamin D]].
===Laboratory Tests===
===Laboratory Tests===
====Haematology====
====Haematology====
*[[Changes in Inflammatory Cells Circulating in Blood - Pathology #Lymphopenia|Lymphopaenia]]
*[[Changes in Inflammatory Cells Circulating in Blood - Pathology #Lymphopenia|Lymphopaenia]]
====Biochemistry====
====Biochemistry====
*Panhypoproteinaemia
**Hypoglobulinaemia with hypoalbuminaemia is a pattern more suggestive of PLE as albumin is lost in excess of globulin in protein-losing nephropathy.
*Hypocholesterolaemia
*Hypocholesterolaemia
*[[Hypocalcaemia - Small Animal|Hypocalcaemia]]
*[[Hypocalcaemia - Small Animal|Hypocalcaemia]]
**Ionised calcium concentration should be measured to determine the significance of this finding as serum calcium concentration will fall as protein levels fall.
====Other Tests====
====Other Tests====
*Measurement of faecal loss alpha1-protease inhibitor
*Measurement of faecal alpha1-protease inhibitor
===Histopathology===
===Histopathology===
*Endoscopically-guided multiple biopsies are useful. Surgical biopsy may be required for a definitive diagnosis of lymphoma and [[Lymphangiectasia#Description|secondary lymphangiectasia]]. A small fatty meal could be given the night before biopsy to increase the chance of diagnosing [[Lymphangiectasia|lymphangiectasia]].
*Endoscopically-guided multiple biopsies are useful. Surgical biopsy may be required for a definitive diagnosis of lymphoma and [[Lymphangiectasia#Description|secondary lymphangiectasia]]. A small fatty meal could be given the night before biopsy to increase the chance of diagnosing [[Lymphangiectasia|lymphangiectasia]].
*Animals with PLE have a greater risk of biopsy site dehiscence with the subsequent development of peritonitis.
==Treatment==
==Treatment==
Treatment of the underlying cause of disease, if possible.
===Plasma transfusion===
===Plasma transfusion===
*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.
*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 [[Colloids|colloid]] may be more suitable if it is essential to increase the plasma oncotic pressure.
*Administration of [[Colloids|colloid]] may be more suitable if it is essential to increase the plasma oncotic pressure.
===Diuretics===
===[[Diuretics]]===
*This can be used to reduce ascites.
*These can be used to reduce ascites.
*[[Heart Failure, Treatmen#C. Pharmacological |Spironolactone]] may be more effective than [[Heart Failure, Treatment#C. Pharmacological|frusemide]].
*[[Heart Failure, Treatmen#C. Pharmacological |Spironolactone]] may be more effective than [[Heart Failure, Treatment#C. Pharmacological|frusemide]].
[[Category:Intestine_-_Inflammatory_Pathology]]
[[Category:Intestine_-_Inflammatory_Pathology]]
[[Category:To_Do_-_Clinical]]
[[Category:To_Do_-_Clinical]]
[[Category:To_Do_-_James]]
[[Category:To_Do_-_James]]