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| {{dog}} | | {{dog}} |
− | | + | {{cat}} |
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| ==Signalment== | | ==Signalment== |
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| '''Lymphangiectasia''' is characterised by dilation and dysfunction of the lymphatic vessels of the intestines. Consequently, protein rich lymph leaks into the intestinal lumen, causing a protein-losing enteropathy and severe lipid malabsorption. It is relatively common in dogs but rare in cats. | | '''Lymphangiectasia''' is characterised by dilation and dysfunction of the lymphatic vessels of the intestines. Consequently, protein rich lymph leaks into the intestinal lumen, causing a protein-losing enteropathy and severe lipid malabsorption. It is relatively common in dogs but rare in cats. |
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− | Lymphangiectasia can be classified as primary or secondary. '''Primary lymphangiectasia''' may form part of of a localised or a more widespread lymphatic abnormality. '''Secondary lymphangiectasia''' is the result of lymphatic obstruction. The obstruction may be caused by: | + | Lymphangiectasia can be classified into a primary or a secondary lymphangiectasia. '''Primary lymphangiectasia''' may form part of a localised or a more widespread lymphatic abnormality. '''Secondary lymphangiectasia''' results from lymphatic obstruction, which may be caused by: |
− | *inflammation, neoplastic infiltration o fibrosis | + | *inflammation, neoplastic infiltration or fibrosis |
| *thoracic duct obstruction | | *thoracic duct obstruction |
| *right sided cardiac failure | | *right sided cardiac failure |
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| *hepatic disease | | *hepatic disease |
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− | Lymphagiectasia often accompanies a lipogranulomatous inflammation, but it is not clear which is the primary event. Lymphangitis can cause lymphatic obstruction but the leakage of lymph can cause a granuloma to form.
| + | Lymphangiectasia often accompanies a lipogranulomatous inflammation, but it is not clear which is the primary event. Lymphangitis can cause lymphatic obstruction but the leakage of lymph can also cause a granuloma to form. |
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| ===Clinical Signs=== | | ===Clinical Signs=== |
| *Weight loss | | *Weight loss |
− | *Chronic diarrhoea, steatorrhoea | + | *Chronic diarrhoea; steatorrhoea |
| *Ascites, oedema or chylothorax may result if there is severe hypoproteinaemia or lymphatic obstruction | | *Ascites, oedema or chylothorax may result if there is severe hypoproteinaemia or lymphatic obstruction |
| *Increased appetite | | *Increased appetite |
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| ====Other Tests==== | | ====Other Tests==== |
− | *Faeacal α1-proteinase inhibitor concentrations or chromium 51-labelled albumin may be used to confirm protein-losing enteropathy. | + | *Faecal α1-proteinase inhibitor concentrations or chromium 51-labelled albumin may be used to confirm protein-losing enteropathy. |
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| ===Diagnostic Imaging=== | | ===Diagnostic Imaging=== |
| ====Ultrasound==== | | ====Ultrasound==== |
− | Abdominal ultrasonography may reveal pleural fluid or ascites as well as help to narrow down other differential diagnoses. Mucosa of intestinal loops may appear thickened due to oedema. | + | Abdominal ultrasonography may reveal pleural fluid or ascites as well as helping to narrow down other differential diagnoses. Mucosa of intestinal loops may appear thickened due to oedema. |
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| ====Endoscopy==== | | ====Endoscopy==== |
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| Refer to [[Intestines Inflammatory Bowel Disease And Related Conditions - Pathology #Lymphangiectasia|Lymphangiectasia]] for pathology | | Refer to [[Intestines Inflammatory Bowel Disease And Related Conditions - Pathology #Lymphangiectasia|Lymphangiectasia]] for pathology |
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− | It is essential to distinguish a true lymphangiectasia from a secondary lacteal dilation due to [[Inflammatory Bowel Disease - WikiClinical|Inflammatory Bowel Disease ]] (IBD). In the case of IBD, inflammtory infiltrate will be seen in the lamina propria, but the degree of infiltration may be underestimated if oedema is present. | + | It is essential to distinguish a true lymphangiectasia from a secondary lacteal dilation due to [[Inflammatory Bowel Disease - WikiClinical|Inflammatory Bowel Disease ]] (IBD). In the case of IBD, inflammatory infiltrate will be seen in the lamina propria, but the degree of infiltration may be underestimated if oedema is present. |
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| ==Treatment== | | ==Treatment== |
− | *Identify and treat the underlying cause if it is caused by secondary lymphangiectasia | + | *Identify and treat the underlying cause if it is a secondary lymphangiectasia |
| + | *Fat-restricted diet |
| + | **The diet needs to be calorific and highly digestible |
| *Supplementation of fat soluble vitamins | | *Supplementation of fat soluble vitamins |
| *Anecdotal report of glutamine supplementation | | *Anecdotal report of glutamine supplementation |
− | *Prednisolone at 0.5-1.0 mg/kg PO BID | + | *Prednisolone at 1-2 mg/kg/day PO |
| **Anti-inflammatory and immunosuppressive effect may be beneficial | | **Anti-inflammatory and immunosuppressive effect may be beneficial |
− | **This is particularly true if there is associated lymphangitis, lipogranulomas and a lymphocytic-plasmacytic infiltration of the lamina propria. | + | **This is particularly true if there is associated lymphangitis, lipogranulomas or a lymphocytic-plasmacytic infiltration of the lamina propria. |
| + | **Azathioprine at 2.2 mg/kg q48 hours or Ciclosporin at 3-5 mg/kg q24 to 12 hours can also be considered |
| *Antimicrobials such as metronidazole or tylosin | | *Antimicrobials such as metronidazole or tylosin |
− | **This may be beneficial due to their potential immunomodulatory effect and modulation of enteric flora | + | **This may be beneficial due to their potential immunomodulatory effect and modulation of the enteric flora |
− | *Diuretics, preferably combinations, such as frusemide and spironolactone are used to treat effusions. | + | *Diuretics such as frusemide and spironolactone are used to manage effusions. |
− | *Short term treatment with plasma or colloids can be given for plasma expandsion. | + | *Short term treatment with plasma or colloids can be given for plasma expansion. |
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| ==Prognosis== | | ==Prognosis== |
− | Guarded. The response to treatment is generally poor although some dogs may do well. Dogs in may be in remission for several years but the disease eventually progress to fulminant hypoproteinaemia. | + | Guarded. The response to treatment is generally poor although some dogs may do well. Dogs may be in remission for several years but the disease eventually progress to fulminant hypoproteinaemia. |
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