Difference between revisions of "Protein Losing Enteropathy"
| Line 39: | Line 39: | ||
====Other Tests==== | ====Other Tests==== | ||
| − | + | *Measurement of faecal loss alpha1-protease inhibitor | |
===Diagnostic Imaging=== | ===Diagnostic Imaging=== | ||
| + | ====Radiography==== | ||
| + | *Abdominal radigraps are usually unremarkable. | ||
| + | *Thoracic radiographs may show pleural effusion, metastatic neoplasia or eveidence of histoplasmosis. | ||
| + | ====Ultrasonography==== | ||
| + | *This may reveal thickening of intestines, mesenteric lymphadenopathy or abdominal effusion. | ||
===Histopathology=== | ===Histopathology=== | ||
| − | + | *Endoscopically guided multiple biopsies are useful. However, surgical biopsy may be required for a definitive diagnosis of lymphoma and secondary lymphangiectasia. | |
==Treatment== | ==Treatment== | ||
| + | ===Plasma transfusion=== | ||
| + | *This may be required to increase plasma volume perioperatively. | ||
| + | ===Diuretics=== | ||
| + | *This can be used to reduce ascites | ||
| + | *Spironolactone 1-2 mg/kg PO BID may be more effective than frusemide. | ||
Revision as of 10:18, 18 August 2009
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This article is still under construction. |
Signalment
Breed predisposition:
- Basenji
- Lundehund
- Soft-coated wheaten terrier
- Yorkshire terrier
- Shar Pei
Description
Protein-losing enteropathy (PLE) can result from any intestinal disease which produces sufficienct inflammation, congestion or bleeding. This causes protein to leak into the intestines, which exceeds the gut lumen protein synthesis. Hence, there are numerous causes of PLE, for example lymphangiectasia, infectious, structural, neoplasia, inflammation, endoparasites and gastrointestinal haemorrhage. Most common causes in adult dogs are inflammatory bowel disease and alimentary tract lymphoma, whereas most common causes in very young dogs are hookworms and chronic intussusception. PLE is less common in cats than dogs, and most often caused by gastrointestinal lymphoma. Non-intestinal diseases which can be associated with PLE include congestive heart failure, caval obstruction and portal hypertension. However, these animals usually present with ascites rather than diarrhoea.
Diagnosis
Clinical Signs
- Weight loss (predominant feature)
- Vomiting and diarrhoea ± melena
- Oedema, ascites and pleural effusion
- Thickened intestines
- Thromboembolic disease if procoagulants predominant due to loss of anticoagulant
Laboratory Tests
Haematology
- Panhypoproteinaemia
- Lymphopaenia
Biochemistry
- Hypocholesterolaemia
- Hypocalcaemia
Other Tests
- Measurement of faecal loss alpha1-protease inhibitor
Diagnostic Imaging
Radiography
- Abdominal radigraps are usually unremarkable.
- Thoracic radiographs may show pleural effusion, metastatic neoplasia or eveidence of histoplasmosis.
Ultrasonography
- This may reveal thickening of intestines, mesenteric lymphadenopathy or abdominal effusion.
Histopathology
- Endoscopically guided multiple biopsies are useful. However, surgical biopsy may be required for a definitive diagnosis of lymphoma and secondary lymphangiectasia.
Treatment
Plasma transfusion
- This may be required to increase plasma volume perioperatively.
Diuretics
- This can be used to reduce ascites
- Spironolactone 1-2 mg/kg PO BID may be more effective than frusemide.
Prognosis
References
- Ettinger, S.J. and Feldman, E. C. (2000) Textbook of Veterinary Internal Medicine Diseases of the Dog and Cat Volume 2 (Fifth Edition) W.B. Saunders Company.
- Hall, E.J, Simpson, J.W. and Williams, D.A. (2005) BSAVA Manual of Canine and Feline Gastroenterology (2nd Edition) BSAVA
- Nelson, R.W. and Couto, C.G. (2009) Small Animal Internal Medicine (Fourth Edition) Mosby Elsevier.