829
edits
Changes
Jump to navigation
Jump to search
no edit summary
*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]] (including lymphocytic-plasmacytic enteritis, eosinophilic enteritis, granulomatous enteritis and histiocytic-ulcerative colitis)
**[[Inflammatory Bowel Disease]] (including lymphocytic-plasmacytic enteritis, eosinophilic enteritis, granulomatous enteritis and histiocytic-ulcerative colitis)
**Infectious disease
**Infectious disease
***Giardia duodenalis
***''Giardia duodenalis''
***[[Uncinaria stenocephala|Hookworm]]
***[[Uncinaria stenocephala|Hookworm]]
***[[Systemic Mycoses #Histoplasmosis|Histoplasmosis]]
***[[Systemic Mycoses #Histoplasmosis|Histoplasmosis]]
**Chronic intussusception in juvenile animals
**Chronic intussusception in juvenile animals
*Infiltrative disase
*[[Lymphangiectasia]]
*Infiltrative disease
**Alimentary lymphoma
**Alimentary lymphoma
*Congestion
*Venous congestion
**Portal hypertension
**Portal hypertension
**Posterior caval syndrome
**Posterior caval syndrome
**[[Heart Failure - Pathophysiology|Right-sided congestive heart failure]]
**[[Heart Failure - Pathophysiology|Right-sided congestive heart failure]]
*GI haemorrhage
*GI haemorrhage
**e.g., hypoadrenocorticism, ischaemia
**This may occur with hypoadrenocorticism or with other causes of GI ulceration
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 but lymphangiectasia occurs 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:
Rare causes of PLE include:
* Small intestinal bacterial overgrowth
* Small intestinal bacterial overgrowth (SIBO)
* Hypoalbunimaemia causing intestinal mural oedema
* Hypoalbunimaemia causing intestinal mural oedema
* Increased activation of tissue plasminogen activator
* Increased activation of tissue plasminogen activator
* Systemic lupus erythematosis (SLE)
* Systemic lupus erythematosis (SLE)
* Chemotherapy/radiotherapy
* Chemotherapy or radiotherapy
==Signalment==
==Signalment==
The following breeds of dog may be afflicted:
The following breeds of dog show a predisposition for PLE:
*Basenji
*'''Basenji''', related to secretory enteropathy
*Lundehund
*'''Lundehund'''
*Soft-Coated Wheaten Terrier
*'''Soft-Coated Wheaten Terriers''', which may have concurrent [[Protein Losing Nephropathy|protein-losing nephropathy]]. Most affected animals of this breed have a common ancestor (thought to have lived in the USA) and females are more commonly affected than males
*Yorkshire Terrier
*Yorkshire Terrier
*Shar Pei
*Shar Pei
*'''Diarrhoea''' occurs due to the loss of protein into the GI tract and subsequent osmotic movement of fluid. Melaena may occur with GI haemorrhage.
*'''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''' may be detectable on abdominal palpation and this may be related to the primary pathological process.
*'''Thickened intestines''' may be detectable on abdominal palpation and this finding 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 plasma anticoagulants such as antithrombin III.
*'''Hypocalcaemic tetany''' due to a reduced ability to absorb the fat soluble [[Vitamin D|vitamin D]].
*'''Hypocalcaemic tetany''' due to a reduced ability to absorb the fat soluble [[Vitamin D|vitamin D]].
====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.
**This marker has a similar molecular weight to albumin and it is lost into the GI tract in PLE. Its concentration can therefore 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
*Administration of 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.
**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====
The results of '''abdominal radiographs''' are usually unremarkable but discrete mass lesions or ascites may be evident. '''Thoracic radiographs''' may show the presence of [[Effusions|pleural effusion]], metastatic neoplasia or evidence of [[Systemic Mycoses #Histoplasmosis|histoplasmosis]]).
====Ultrasonography====
====Ultrasonography====
**Changes to intestinal wall structure, including:
**Changes to intestinal wall structure, including:
***Thickening without loss of normal layers (as with inflammatory bowel disease)
***Thickening without loss of normal layers (as with inflammatory bowel disease)
***Thickening with loss of layers (as with intestinal neoplasia)
***Thickening with loss of layers (as with infiltrative intestinal neoplasia)
***'Tiger stripes', an unreliable indicator of lymphangiectasia
***'Tiger stripes', an unreliable indicator of lymphangiectasia
**Ascites or pleural effusion
**Ascites or pleural effusion
===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]].
'''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.
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.
** Dilated lymphatics
** Dilated lymphatics
** Lipogranulomatous lymphangitis, especially in Soft-coated Wheaten terriers
** Lipogranulomatous lymphangitis, especially in Soft-coated Wheaten terriers
* PLE may also be associated with protein losing nephropathy (PLN).
* PLE may also be associated with protein losing nephropathy (PLN).
** PLN may be a chronic sequelae to the PLE.
** PLN may be a chronic sequelae to the PLE.
====Plasma transfusion====
====Plasma transfusion====
This may be used to increase plasma volume but, as much of the albumin is lost into the gut, there may be a disappointing increase in serum albumin concentration after transfusion. Large [[Colloids|colloids]] (such as hetastarch) may also be administered to try to maintain plasma oncotic pressure.
====[[The Effects of Diuretics on the Kidneys - Anatomy & Physiology|Diuretics]]====
====[[The Effects of Diuretics on the Kidneys - Anatomy & Physiology|Diuretics]]====
These may be used to reduce any ascites or pleural effusion and it has been suggested that [[Heart Failure, Treatment#C. Pharmacological |spironolactone]] may be more effective than [[Heart Failure, Treatment#C. Pharmacological|frusemide]] for this purpose.
====Antithrombotic therapy====
====Antithrombotic therapy====
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.
==Prognosis==
==Prognosis==