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600 Lymphangiectasia/Protein-Losing Enteropathy

• Metastatic lesions or lymphoma with extra- Technician Tips SUGGESTED READING
capsular invasion of nodes are adherent to • For generalized lymphadenopathy, the Couto CG: Lymphadenopathy and splenomegaly. In
VetBooks.ir • Marked generalized lymphadenopathy the most easily accessible for fine-needle AUTHOR: Paolo Pazzi, BVSc, MMedVet, DECVIM
popliteal and prescapular lymph nodes are
underlying tissue.
Nelson RW, et al, editors: Small animal internal
medicine, St. Louis, 2013, Mosby, pp 1264-1278.
aspiration and unaffected by oral disease
(enlarged 5-10 times) occurs almost exclusively
(gingivitis).
in dogs with lymphoma or in cats with
lymphoma or lymph node hyperplasia. • Ensure adequate platelets before lymph node EDITOR: Leah A. Cohn, DVM, PhD, DACVIM
aspiration.
Prevention
Tick and flea control

Lymphangiectasia/Protein-Losing Enteropathy Client Education
Sheet

BASIC INFORMATION • Intestinal neoplasia (e.g., lymphoma, • Several mechanisms (alone or in combina-
adenocarcinoma) tion) contribute to intestinal protein loss
Definition • Mechanical enteropathy (e.g., chronic foreign (see Associated Disorders above).
• Intestinal lymphangiectasia: intestinal lacteal body, chronic intussusception) ○ Abnormalities of intestinal lymphatics
(lymphatic) abnormalities commonly result • GI ulceration cause leakage of lymph.
in protein-losing enteropathy (PLE). • Lymphatic compromise/dysfunction ○ Increased intestinal permeability permits
• PLE: gastrointestinal (GI) disease or dysfunc- ○ Confined to GI tract (i.e., intestinal protein loss.
tion causing enteric protein loss; results in lymphangiectasia) ○ Intestinal mucosal erosion and ulceration
hypoalbuminemia ± hypoglobulinemia ○ Generalized results in protein loss.
○ Protein loss can occur with acute and • Venous hypertension (portal hypertension, ○ Elevated venous pressures result in protein
chronic GI diseases. right-sided cardiac disease, pericardial leakage.
○ The term PLE is usually reserved for disease) • Hypoalbuminemia results in decreased
chronic disorders. • Low plasma oncotic pressure oncotic pressure and leakage of fluid into
○ May be associated with GI blood loss ○ Ascites, pleural effusion, pitting edema interstitial spaces, causing peripheral edema,
• Anemia secondary to ulcerative or erosive ascites, and/or pleural effusion.
Epidemiology GI disease • Loss of anticoagulant proteins, including
SPECIES, AGE, SEX ○ Microcytosis suggests iron deficiency. antithrombin, results in a prothrombotic
• Dogs affected more commonly than cats • Thromboembolic complications from loss state.
• Any age; breed-associated disorders usually of antithrombin
reported for young or middle-aged dogs ○ May affect lungs, brain, and limbs DIAGNOSIS
GENETICS, BREED PREDISPOSITION Clinical Presentation Diagnostic Overview
• Basenji: immunoproliferative enteropathy HISTORY, CHIEF COMPLAINT Preliminary diagnostic tests confirm intestinal
• Norwegian lundehund: intestinal • May show no overt clinical signs; hypoal- protein loss and rule out other causes of hypoal-
lymphangiectasia buminemia may be an incidental finding. buminemia. Not all patients have diarrhea, and
• Soft-coated wheaten terrier: PLE with • Weight loss is common and may be the only the absence of GI signs does not exclude this
protein-losing nephropathy (PLN) clinical sign. diagnosis. More advanced testing defines the
• Yorkshire terrier: intestinal lymphangiectasia • Chronic small-bowel diarrhea may or may disorder and provides a targeted treatment plan.
± concurrent inflammatory bowel disease not be present.
• German shepherd, rottweiler, Chinese Shar- • Abdominal distention if ascites present Differential Diagnosis
pei: all appear predisposed to PLE • Respiratory distress possible with pleural Differential diagnosis for hypoalbuminemia:
• French bulldogs: appear predisposed to focal effusion, tense ascites, or pulmonary • PLN, liver disease
lipogranulomatous lymphangitis thromboembolism (PTE) • Glucocorticoid-deficient hypoadrenocorti-
○ Thromboembolism may also cause central cism (i.e., atypical Addison’s disease)
CONTAGION AND ZOONOSIS neurologic signs or limb dysfunction. • Other causes of albumin loss from the
Chronic salmonellosis is possible in febrile or vascular space
immunocompromised patients. Other infec- PHYSICAL EXAM FINDINGS ○ Peritonitis, pleuritis, vasculitis
tious causes of chronic PLE are not directly • Weight loss, emaciation ○ Severe dermal burns or exudative
contagious. • Thickened intestinal loops or mass effects dermatitis
may be noted on abdominal palpation. ○ GI bleeding or parasitism
GEOGRAPHY AND SEASONALITY • Ascites and/or peripheral edema (generally • Protein malnutrition
Histoplasma capsulatum, Heterobilharzia ameri- when serum albumin < 1.5 g/dL)
cana, and Pythium insidiosum in endemic areas • Dyspnea or tachypnea with pleural effusion, Initial Database
tense ascites, and/or PTE • CBC
ASSOCIATED DISORDERS • Soft stool or melena may be noted on rectal ○ Anemia possible (GI hemorrhage, chronic
• Inflammatory bowel disease (IBD) exam. inflammation); microcytosis, with/without
• Adverse food reactions (e.g., gluten-sensitive hypochromasia, may reflect iron deficiency.
enteropathy) Etiology and Pathophysiology ○ Lymphopenia common with lymphangiec-
• GI infection (e.g., histoplasmosis, salmonel- • Hypoalbuminemia occurs when protein loss tasia; absence of lymphopenia may create
losis, hookworms) exceeds hepatic albumin synthesis. suspicion for hypoadrenocorticism.

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