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==Description==
==Description==
'''Protein-losing enteropathy (PLE)''' refers to the loss of plasma proteins into the gastro-intestinal tract, exceeding the absorptive capacity of the intestines. PLE can be caused by:
'''Protein-losing enteropathy (PLE)''' refers to the loss of plasma proteins into the gastro-intestinal (GI) tract, exceeding the absorptive capacity of the intestines. PLE can be caused by:
*Disruption to the intestinal wall due to [[Inflammation - Pathology|inflammation]] or infiltrative disease
*Disruption to the intestinal wall due to [[Inflammation - Pathology|inflammation]] or infiltrative disease
*Congestion caused by portal hypertension, posterior caval syndrome or right-sided heart failure
*Venous congestion of the GI tract
*Gastro-intestinal haemorrhage
*GI [[Haemorrhage - pathology|haemorrhage]]
Hence, there are numerous causes of PLE in cats and dogs , including [[Lymphangiectasia|lymphangiectasia]], infectious causes, structural causes, neoplasia, [[Inflammation - Pathology|inflammation]], endoparasites and gastrointestinal [[Haemorrhage - Pathology|haemorrhage]].
Hence, there are numerous causes of PLE in cats and dogs , including:
*Inflammation
**[[Inflammatory Bowel Disease]] (including lymphocytic-plasmacytic enteritis, eosinophilic enteritis, granulomatous enteritis and histiocytic-ulcerative colitis)
**Uraemic gastritis and colitis
**[[Lymphangiectasia]]
**Infectious disease
***Giardia duodenalis
***[[Uncinaria stenocephala|Hookworm]]
***[[Systemic Mycoses #Histoplasmosis|Histoplasmosis]]
**Chronic intussusception in juvenile animals
*Infiltrative disase
**Alimentary lymphoma
*Congestion
**Portal hypertension
**Posterior caval syndrome
**[[Heart Failure - Pathophysiology|Right-sided congestive heart failure]]
*GI haemorrhage
**e.g., hypoadrenocorticism, ischaemia
Inflammatory bowel disease and lymphoma are the most common causes of PLE in both cats and dogs, with lymphangiectasia occurring much more commonly in dogs than in cats. Chronic intussuscepta (usually occurring secondary to acute enteritis) and endoparasite infection are the most common causes of PLE in juvenile cats and dogs.
==Signalment==
==Signalment==
*Soft-Coated Wheaten Terrier
*Soft-Coated Wheaten Terrier
**May have concurrent [[Protein Losing Nephropathy|protein-losing nephropathy]]
**May have concurrent [[Protein Losing Nephropathy|protein-losing nephropathy]]
**Most affected animals have a common ancestor
**Most affected animals have a common ancestor
**Females are more commonly affected that males
**Females are more commonly affected than males
*Yorkshire Terrier
*Yorkshire Terrier
*Shar Pei
*Shar Pei
==Diagnosis==
==Diagnosis==
===Clinical Signs===
===Clinical Signs===
*Weight loss (predominant feature).
*'''Weight loss''' is the most evident sign.
*Vomiting and diarrhoea ± melaena.
*'''Diarrhoea''' occurs due to the loss of protein into the GI tract and subsequent osmotic movement of fluid. Melaena may occur with GI haemorrhage.
*[[Oedema - Pathology|Oedema]], ascites and pleural effusion due to reduced plasma oncotic pressure.
*[[Oedema - Pathology|'''Oedema''']], '''ascites''' and '''pleural effusion''' due to reduced plasma oncotic pressure.
*Thickened intestines related to the pathological process.
*'''Thickened intestines''' may be detectable on abdominal palpation and this may be related to the primary pathological process.
*[[Thromboembolism|Thromboembolic]] disease due to the loss of anticoagulants such as antithrombin III.
*[[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]].
*'''Hypocalcaemic tetany''' due to a reduced ability to absorb the fat soluble [[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]]''' occurs with lymphangiectasia due to the loss of lymph.
====Biochemistry====
====Biochemistry====
*Panhypoproteinaemia
*'''Panhypoproteinaemia'''
**Hypoglobulinaemia with hypoalbuminaemia is a pattern more suggestive of PLE as albumin is lost in excess of globulin in protein-losing nephropathy.
**Hypoglobulinaemia with hypoalbuminaemia is a pattern more suggestive of PLE.
*Hypocholesterolaemia
**Albumin is usually lost in excess of globulin in protein losing nephropathy.
*[[Hypocalcaemia - Small Animal|Hypocalcaemia]]
*'''Hypocholesterolaemia''', especially in lymphangiectasia.
**Ionised calcium concentration should be measured to determine the significance of this finding as serum calcium concentration will fall as protein levels fall.
*[[Hypocalcaemia - Small Animal|'''Hypocalcaemia''']]
**Ionised calcium concentration should be measured to determine the significance of this finding as serum calcium concentration is closely related to total protein level.
====Other Tests====
====Other Tests====
*Measurement of faecal alpha1-protease inhibitor
*Measurement of faecal alpha1-protease inhibitor
**This marker has a similar molecular weight to albumin and it is lost into the GI tract in PLE. Its concentration can be measured in faeces as it is not degraded by GI enzymes. Faecal samples must be frozen on collection before submission to a laboratory in the USA.
*51-Chromium labelled albumin
**A radioactive marker (51-Chromium) is attached to recombinant albumin molecules before injection into animal. Faecal samples are collected to determine whether the labelled albumin is being lost into the GI tract. Although this test represents the 'gold standard' test, it is available only at a limited number of referral institutes.
===Diagnostic Imaging===
===Diagnostic Imaging===
====Radiography====
====Radiography====
*Abdominal radiographs are usually unremarkable.
*Abdominal radiographs
*Thoracic radiographs may show [[Effusions|pleural effusion]], metastatic neoplasia or eveidence of [[Systemic Mycoses #Histoplasmosis|histoplasmosis]]).
**The results are usually unremarkable but discrete mass lesions or ascites may be evident.
*Thoracic radiographs
**These may show the presence of [[Effusions|pleural effusion]], metastatic neoplasia or eveidence of [[Systemic Mycoses #Histoplasmosis|histoplasmosis]]).
====Ultrasonography====
====Ultrasonography====