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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:
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==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.
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==Protein-Losing Enteropathy (PLE)==
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* Affects soft coated wheaten terriers.
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** Common male ancestor for most of the dogs.
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** Bitches are affected more often than dogs.
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** Also affects Besenji, Lundehund.
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* Normally, dietary protein and protein from shed enterocytes is almost completely absorbed.
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** In PLE there is excess loss of protein into the gut lumen.
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*** The loss is non-selective i.e. albumin and globulin.
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** Causes panhypoproteinaemia and hypocholesterolaemia.
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* If this is severe, oedema and weight loss may result.
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* Enteropathy not due to gluten sensitivity.
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* Can diagnose PLE on basis of finding α1-protease inhibitor in the faeces in dogs.
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===Causes of PLE===
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* Severe inflammatory disease.
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** Protein is lost in exudate.
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* [[Lymphangiectasia|Lymphangiectasia]].
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** Loss of protein-rich lymph due to obstruction of gut lymphatics.
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* Increased mucosal permeability.
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** E.g. erosions, loss of tight junctions, lymphosarcoma.
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* Increased loss of enterocytes (less important).
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* Also:
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** Immunoproliferative enteropathy
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** Lymphocytic plasmacytic enteritis
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** Eosinophilic enteritis
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** GI ulceration/erosion
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** Giardiasis
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** Chronic intussusception
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** Small intestinal bacterial overgrowth
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** Neoplasia
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** Hypoalbunimaemia causing mural oedema
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** Increased activation of tissue plasminogen activator
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** Systemic lupus erythematosis (SLE)
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** Vascular lesion in the GI mucosa
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** Chemotherapy/radiotherapy.
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===Pathology===
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* Lesions include:
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** Inflammatory bowel disease
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** Dilated lymphatics
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** Lipogranulomatous lymphangitis.
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* Intestinal crypts become dilated with mucus, sloughed epithelial cells with or without inflammatory cells.
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* PLE is also associated with protein losing nephropathy (PLN).
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** PLN may be a chronic sequelae to the PLE.
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** Follows immune complex deposition in the glomerulus, causing glomerulonephritis or glomerulosclerosis.
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** PLN causes hypoalbunaemian and hypercholesterolaemia.
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** Similar PLN and PLE lesions seen in young Besenjis with immunoproliferative enteropathy and glomerulosclerosis.
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==Literature Search==
 
==Literature Search==
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*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''.
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[[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]]
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[[Category:To Do - Clinical]]
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