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==Introduction==
==Introduction==
'''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:
'''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:
==Prognosis==
==Prognosis==
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.
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.
==Protein-Losing Enteropathy (PLE)==
* Affects soft coated wheaten terriers.
** Common male ancestor for most of the dogs.
** Bitches are affected more often than dogs.
** Also affects Besenji, Lundehund.
* Normally, dietary protein and protein from shed enterocytes is almost completely absorbed.
** In PLE there is excess loss of protein into the gut lumen.
*** The loss is non-selective i.e. albumin and globulin.
** Causes panhypoproteinaemia and hypocholesterolaemia.
* If this is severe, oedema and weight loss may result.
* Enteropathy not due to gluten sensitivity.
* Can diagnose PLE on basis of finding α1-protease inhibitor in the faeces in dogs.
===Causes of PLE===
* Severe inflammatory disease.
** Protein is lost in exudate.
* [[Lymphangiectasia|Lymphangiectasia]].
** Loss of protein-rich lymph due to obstruction of gut lymphatics.
* Increased mucosal permeability.
** E.g. erosions, loss of tight junctions, lymphosarcoma.
* Increased loss of enterocytes (less important).
* Also:
** Immunoproliferative enteropathy
** Lymphocytic plasmacytic enteritis
** Eosinophilic enteritis
** GI ulceration/erosion
** Giardiasis
** Chronic intussusception
** Small intestinal bacterial overgrowth
** Neoplasia
** Hypoalbunimaemia causing mural oedema
** Increased activation of tissue plasminogen activator
** Systemic lupus erythematosis (SLE)
** Vascular lesion in the GI mucosa
** Chemotherapy/radiotherapy.
===Pathology===
* Lesions include:
** Inflammatory bowel disease
** Dilated lymphatics
** Lipogranulomatous lymphangitis.
* 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.
==Literature Search==
==Literature Search==
*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''.
[[Category:Intestine_-_Inflammatory_Pathology]]
[[Category:Intestine_-_Inflammatory_Pathology]]
[[Category:Intestinal Diseases - Cat]][[Category:Intestinal Diseases - Dog]][[Category:Alimentary_Disorders]]
[[Category:Intestinal Diseases - Cat]][[Category:Intestinal Diseases - Dog]][[Category:Alimentary_Disorders]]
[[Category:Expert_Review]]
[[Category:To Do - Clinical]]