Page 768 - Problem-Based Feline Medicine

760 PART 9 CAT WITH SIGNS OF GASTROINTESTINAL TRACT DISEASE

lymphangiectasia or idiopathic PLE as is reported in
PROTEIN-LOSING ENTEROPATHY
dogs.
Classical signs Other causes for low albumin and serum protein
levels must be considered when this abnormality is dis-
● Weight loss, poor hair coat, inappetance,
covered, e.g. renal protein loss, severe hepatic disease,
and chronic (may be intermittent) diarrhea.
third space loss, and severe protein calorie malnutri-
tion.
Pathogenesis

Primary lymphangiectasia is rare as a cause of Treatment
protein-losing enteropathy (PLE) in cats. Most cats
Treatment of PLE is directed solely at correction of
have PLE secondary to IBD or lymphosarcoma.
the primary disease process. Specific therapy for lym-
PLE in cats may be associated with other severe mal- phoma or IBD will correct or at least control the cause
absorptive or infiltrative diseases (e.g. histoplasmo- of the protein loss.
sis, exocrine pancreatic insufficiency), but these are
Symptomatic therapy for severe intestinal protein loss
rare causes of protein loss in cats.
includes a highly digestible diet. Alternative sources
of protein for inclusion in the diet are hydrolyzed pro-
Clinical signs tein diets (Hill’s z/d) and elemental diets (e.g.
Vivonex).
The clinical signs are dependent on the primary
cause of the PLE. Cat may have anorexia and weight Medium chain triglyceride (MCT) oil is not recom-
loss only, or have chronic unrelenting diarrhea, along mended for use in cats, as it is in dogs, because of the
with inappetance. increased risk of hepatic lipidosis.
Most cats are middle-aged to older, typical of the age
range for IBD or lymphoma. PLE is simply another Prognosis
complication of the primary process and is not
Guarded, as most cats with PLE have a disease that is
a diagnostic entity in cats.
difficult if not impossible to cure.
Diagnosis
SHORT BOWEL SYNDROME
Cats with PLE will have decreased serum total pro-
tein and albumin levels, in addition to other abnor- Classical signs
malities consistent with their primary disease.
● Severe and in some cases intractable
Urinary protein loss, third space loss, lack of ade- small bowel diarrhea.
quate intake and severe hepatic disease must all be
ruled out before considering a diagnosis of PLE. Fecal
Pathogenesis
alpha-1 protease inhibitor levels, a test for abnormal
GI protein loss available for dogs, have not yet been Short bowel syndrome is classically due to surgical resec-
validated for use in cats. tion of a large segment of the small intestine that results
in fluid overload to the colon and resultant diarrhea.
As for many other GI conditions, the definitive diag-
nosis of the inciting cause of PLE is obtained by biopsy. Other causes include ischemic intestinal diseases
such as intussusception, bowel strangulation and
intestinal volvulus.
Differential diagnosis
Intestinal adaptation occurs in the large bowel,
Since PLE is not a definitive diagnosis, a search for which ultimately results in a return to a soft or semi-
the primary cause is essential. Cats rarely develop formed fecal specimen, usually within 2–6 weeks.