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*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
*Venous congestion of the GI tract
*Venous congestion of the GI tract
*GI [[Haemorrhage - pathology|haemorrhage]]
*GI [[Haemorrhage - Pathology|haemorrhage]]
Hence, there are numerous causes of PLE in cats and dogs , including:
Hence, there are numerous causes of PLE in cats and dogs , including:
*Inflammation
*Inflammation
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.
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.
Rare causes of PLE include:
** Small intestinal bacterial overgrowth
** Hypoalbunimaemia causing intestinal mural oedema
** Increased activation of tissue plasminogen activator
** Systemic lupus erythematosis (SLE)
** Chemotherapy/radiotherapy
==Signalment==
==Signalment==
====Ultrasonography====
====Ultrasonography====
*This may reveal thickening of intestines, mesenteric lymphadenopathy or abdominal effusion.
*This may reveal:
**Changes to intestinal wall structure, including:
***Thickening without loss of normal layers (as with inflammatory bowel disease)
***Thickening with loss of layers (as with intestinal neoplasia)
***'Tiger stripes', an unreliable indicator of lymphangiectasia
**Ascites or pleural effusion
**Mesenteric lymphadenopathy
===Histopathology===
===Histopathology===
Endoscopy can be used to visualise the proximal intestinal luminal surface and to obtain grab biopsies. Surgical biopsies may be obtained for 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]].
Care should be taken with this procedure as animals with PLE have a greater risk of surgical wound dehiscence with the subsequent development of peritonitis.
Lesions that may be observed on histopathological analysis of biopsy samples include:
** Inflammatory bowel disease (of various types)
** Dilated lymphatics
** Lipogranulomatous lymphangitis, especially in Soft-coated Wheaten terriers
* Intestinal crypts become dilated with mucus, sloughed epithelial cells with or without inflammatory cells.
* PLE is also associated with protein losing nephropathy (PLN).
** PLN may be a chronic sequelae to the PLE.
** Follows immune complex deposition in the glomerulus, causing glomerulonephritis or glomerulosclerosis.
** PLN causes hypoalbunaemian and hypercholesterolaemia.
** Similar PLN and PLE lesions seen in young Besenjis with immunoproliferative enteropathy and glomerulosclerosis.
==Treatment==
==Treatment==
Treatment of the underlying cause of disease should be initiated, if possible.
Treatment of the underlying cause of disease should be initiated, 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.
===[[The Effects of Diuretics on the Kidneys - Anatomy & Physiology|Diuretics]]===
====[[The Effects of Diuretics on the Kidneys - Anatomy & Physiology|Diuretics]]====
*These can be used to reduce any ascites or pleural effusion.
*These can be used to reduce any ascites or pleural effusion.
*[[Heart Failure, Treatment#C. Pharmacological |Spironolactone]] may be more effective than [[Heart Failure, Treatment#C. Pharmacological|frusemide]].
*[[Heart Failure, Treatment#C. Pharmacological |Spironolactone]] may be more effective than [[Heart Failure, Treatment#C. Pharmacological|frusemide]].
===Antithrombotic therapy===
====Antithrombotic therapy====
*Treatment may be initiated with low dose aspirin to prevent the development of thrombo-embolism.
*Treatment may be initiated with low dose aspirin to prevent the development of thrombo-embolism.
===Dietary Supplementation with Calcium===
====Dietary Supplementation with Calcium====
*Calcium carbonate may be added to the diet if a low serum concentration of ionised calcium is documented.
*Calcium carbonate may be added to the diet if a low serum concentration of ionised calcium is documented.
==Prognosis==
==Prognosis==
This depends on the underlying cause.
This depends on the underlying cause but Soft-coated Wheaten terriers are known to have a median survival time of five months after diagnosis of PLE and of two months if they suffer from concurrent protein-losing nephropathy.
=From Pathology=
=From Pathology=
===Pathology===
===Pathology===
* Lesions include:
* L