Difference between revisions of "Protein Losing Enteropathy"
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− | == Signalment == | + | ==Signalment== |
− | + | Breed predisposition: | |
− | + | *[[Canine Breeds - WikiNormals #Hound Group|Basenji]] | |
− | + | *Lundehund | |
+ | *[[Canine Breeds - WikiNormals #Terrier Group|Soft-Coated Wheaten Terrier]] | ||
+ | *[[Canine Breeds - WikiNormals #Toy Group|Yorkshire Terrier]] | ||
+ | *[[Canine Breeds - WikiNormals #Utility Group|Shar Pei]] | ||
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− | == Diagnosis == | + | ==Description== |
+ | '''Protein-losing enteropathy (PLE)''' can result from any intestinal disease which produces sufficient [[Inflammation - Pathology|inflammation]], congestion or bleeding. This causes protein to leak into the intestines, which exceeds capacity of the gut lumen protein synthesis. Hence, there are numerous causes of PLE, including [[Lymphangiectasia - WikiClinical|lymphangiectasia]], infectious causes, structural causes, neoplasia, [[Inflammation - Pathology|inflammation]], endoparasites and gastrointestinal [[Haemorrhage - Pathology|haemorrhage]]. | ||
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+ | The major causes of PLE in adult dogs are [[Inflammatory Bowel Disease - WikiClinical|inflammatory bowel disease (IBD)]], alimentary tract lymphoma, fungal infections (e.g. [[Systemic Mycoses #Histoplasmosis|histoplasmosis]]). Other causes include ulcerations or erosions, severe disease of intestinal crypts and parasites. The most common causes in very young dogs are [[Small Animals #Nematodes of Dogs - the HOOKWORMS|hookworms]] and chronic intussusception. Chronic intussusception results from acute enteritis which has not resolved completely. The animal shows some clinical improvement but diarrhoea still continues. PLE is less common in cats than dogs, and most often caused by alimentary tract lymphoma and IBD. Cats almost never suffer from [[Lymphangiectasia - WikiClinical|lymphangiectasia]], and rarely have severe parasitic infection severe enough to cause PLE. Non-intestinal diseases can be associated with PLE include ][[Pathophysiology of Heart Failure - Pathology|congestive heart failure]], caval obstruction and portal hypertension. However, these animals usually present with ascites rather than [[Intestine Diarrhoea - Pathology|diarrhoea]]. | ||
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+ | ==Diagnosis== | ||
+ | ===Clinical Signs=== | ||
+ | *Weight loss (predominant feature) | ||
+ | *Vomiting and diarrhoea ± melena | ||
+ | *[[Oedema - Pathology|Oedema]], ascites and pleural effusion | ||
+ | *Thickened intestines | ||
+ | *[[Thrombosis - Pathology #Thromboembolism|Thromboembolic]] disease if procoagulants predominant due to loss of anticoagulant | ||
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===Laboratory Tests=== | ===Laboratory Tests=== | ||
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====Haematology==== | ====Haematology==== | ||
− | [[Lymphopenia| | + | *Panhypoproteinaemia |
+ | **Hepatic insufficiency and protein-losing nephropathy should also be pursued with hypoalbuminaemia. | ||
+ | *[[Changes in Inflammatory Cells Circulating in Blood - Pathology #Lymphopenia|Lymphopaenia]] | ||
====Biochemistry==== | ====Biochemistry==== | ||
− | + | *Hypocholesterolaemia | |
+ | *[[Hypocalcaemia - Small Animal|Hypocalcaemia]] | ||
− | + | ====Other Tests==== | |
+ | *Measurement of faecal loss alpha1-protease inhibitor | ||
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===Diagnostic Imaging=== | ===Diagnostic Imaging=== | ||
====Radiography==== | ====Radiography==== | ||
− | + | *Abdominal radiographs are usually unremarkable. | |
− | + | *Thoracic radiographs may show [[Peritoneal Cavity Effusions - Pathology|pleural effusion]], metastatic neoplasia or eveidence of [[Systemic Mycoses #Histoplasmosis|histoplasmosis]]). | |
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====Ultrasonography==== | ====Ultrasonography==== | ||
− | This may reveal | + | *This may reveal thickening of intestines, mesenteric lymphadenopathy or abdominal effusion. |
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===Histopathology=== | ===Histopathology=== | ||
− | + | *Endoscopically-guided multiple biopsies are useful. Surgical biopsy may be required for a definitive diagnosis of lymphoma and [[Lymphangiectasia - WikiClinical #Description|secondary lymphangiectasia]]. A small fatty meal could be given the night before biopsy to increase the chance of diagnosing [[Lymphangiectasia - WikiClinical|lymphangiectasia]]. | |
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==Treatment== | ==Treatment== | ||
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===Plasma transfusion=== | ===Plasma transfusion=== | ||
− | This may be used to increase plasma volume | + | *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. | |
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− | === | + | ===Diuretics=== |
− | + | *This can be used to reduce ascites. | |
+ | *[[Treatment of Heart Failure - WikiClinical #C. Pharmacological |Spironolactone]] 1-2 mg/kg PO BID may be more effective than frusemide. | ||
==Prognosis== | ==Prognosis== | ||
− | This depends on the underlying cause | + | This depends on the underlying cause. |
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==References== | ==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''. | |
− | Ettinger, S.J. and Feldman, E. C. (2000) '''Textbook of Veterinary Internal Medicine Diseases of the Dog and Cat Volume 2''' (Fifth Edition) | + | *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''. | |
− | Hall, E.J, Simpson, J.W. and Williams, D.A. (2005) '''BSAVA Manual of Canine and Feline Gastroenterology | ||
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− | Nelson, R.W. and Couto, C.G. (2009) '''Small Animal Internal Medicine (Fourth Edition)''' | ||
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− | Willard, M. (2005) '''Protein-Losing Enteropathy in Dogs and Cats''' | ||
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Revision as of 12:20, 18 August 2009
This article is still under construction. |
Signalment
Breed predisposition:
Description
Protein-losing enteropathy (PLE) can result from any intestinal disease which produces sufficient inflammation, congestion or bleeding. This causes protein to leak into the intestines, which exceeds capacity of the gut lumen protein synthesis. Hence, there are numerous causes of PLE, including lymphangiectasia, infectious causes, structural causes, neoplasia, inflammation, endoparasites and gastrointestinal haemorrhage.
The major causes of PLE in adult dogs are inflammatory bowel disease (IBD), alimentary tract lymphoma, fungal infections (e.g. histoplasmosis). Other causes include ulcerations or erosions, severe disease of intestinal crypts and parasites. The most common causes in very young dogs are hookworms and chronic intussusception. Chronic intussusception results from acute enteritis which has not resolved completely. The animal shows some clinical improvement but diarrhoea still continues. PLE is less common in cats than dogs, and most often caused by alimentary tract lymphoma and IBD. Cats almost never suffer from lymphangiectasia, and rarely have severe parasitic infection severe enough to cause PLE. Non-intestinal diseases 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
- Hepatic insufficiency and protein-losing nephropathy should also be pursued with hypoalbuminaemia.
- Lymphopaenia
Biochemistry
- Hypocholesterolaemia
- Hypocalcaemia
Other Tests
- Measurement of faecal loss alpha1-protease inhibitor
Diagnostic Imaging
Radiography
- Abdominal radiographs 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. Surgical biopsy may be required for a definitive diagnosis of lymphoma and secondary lymphangiectasia. A small fatty meal could be given the night before biopsy to increase the chance of diagnosing lymphangiectasia.
Treatment
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.
- Administration of colloid may be more suitable if it is essential to increase the plasma oncotic pressure.
Diuretics
- This can be used to reduce ascites.
- Spironolactone 1-2 mg/kg PO BID may be more effective than frusemide.
Prognosis
This depends on the underlying cause.
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.
- Willard, M. (2005) Protein-Losing Enteropathy in Dogs and Cats 30th World Congress of the WSAVA.