Protein Losing Enteropathy (PLE) in Dogs | Signs & Treatment

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29.10.18

What is protein losing enteropathy in dogs?

Protein-losing enteropathy ( PLE ) refers to an excessive loss of protein from the bloodstream in the intestinal tract. The word “ enteropathy ” means any disease of the intestinal system. Protein losing enteropathy is not a specific disease but quite a syndrome associated with respective gastrointestinal ( GI ) diseases in dogs that result in a loss of protein from the intestines .
normally, small amounts of protein leak out of the blood vessels as they pass through the intestines ; these leaked plasma proteins are broken down and then reabsorbed by the body and used to make more proteins. With PLE, the mucosal layer that lines the inner surface of the intestine is compromised, allowing more protein-rich fluid to leak out than the body can replace. PLE can lead to a state of hypoproteinemia, a condition where there is an abnormally low level of protein in the blood .
There are a issue of diseases that can damage the intestines sufficiently to cause this supernumerary protein loss. chief gastrointestinal disease, heart disease and diseases of the lymphatic organization can all cause PLE.

PLE in dogs can affect any breed or age, but some breeds show a predisposition for sealed disorders linked to PLE. These breeds include the Soft-coated Wheaten Terrier, Basenji, Yorkshire Terrier, Shar Peis and norwegian Lundehund. however, no genetic predisposition has yet been proven .
Protein losing enteropathy (PLE) in dogs

Symptoms of protein losing enteropathy in dogs

While symptoms of PLE in dogs may initially be insidious, if left untreated they can cursorily progress to become dangerous and potentially life threatening. Weight personnel casualty, diarrhea and vomit are the most park clinical signs, but are not present in every subject .
discernible symptoms of PLE in dogs include :

  • Bouts of diarrhoea
  • Chronic diarrhoea
  • Blood-tinged, mucoid, dark, sticky faeces (melaena)
  • Weight loss
  • Lack of energy (lethargy)
  • Difficulty breathing (dyspnoea) (due to fluid accumulation in the chest cavity)
  • Enlarged abdomen, pot-bellied appearance (due to fluid accumulation within the abdomen)
  • Legs and feet may be puffy or swollen (oedema)
  • Decreased appetite (anorexia)
  • Being a “picky” eater
  • Vomiting

dog vomiting full

Your veterinarian may detect extra symptoms on physical examination :

  • Muscle wasting
  • Malnutrition
  • Thickened loops of intestine on palpation
  • Fluid in the abdomen
  • Abnormal rectal exam
  • Increased lymph nodes
  • A heart murmur
  • Dull lung sounds (from fluid on the lungs)

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Causes of protein losing enteropathy in dogs

excessive loss of protein can occur through the gastrointestinal ( GI ) nerve pathway as a resultant role of many conditions but is most normally caused in dogs by inflammatory intestine disease ( excitement of the intestines ) and lymphoma ( cancer of the lymphoid tissues in the GI nerve pathway ) .
Diseases and conditions of the GI tract that can lead to PLE include :

  • Inflammatory bowel disease (IBD), including lymphocytic-plasmacytic enteritis, eosinophilic enteritis, granulomatous enteritis and histiocytic-ulcerative colitis
  • Lymphatic diseases like intestinal lymphangiectasia (pathologic dilation of lymph vessels), lymphoma
  • Viral gastroenteritis – for example, parvovirus
  • Bacterial gastroenteritis – for example, salmonella
  • Fungal gastroenteritis – for example, histoplasmosis
  • Parasitic enteritis – for example, Giardia duodenalis, hookworms and whipworms (a common cause in juvenile animals)
  • Adverse food reactions – for example, food intolerance
  • Mechanical GI disease – for example, chronic foreign body irritation (without creating a blockage)
  • Intestinal cancer – for example, carcinoma, neoplasia
  • Gastrointestinal ulceration (ulcers in the stomach or intestines)
  • Gastrointestinal haemorrhage (this may occur with hypoadrenocorticism or GI ulceration)
  • Chronic intussusception (a common cause in juvenile animals)

There are a phone number of cardiovascular diseases and conditions that can cause of PLE in dogs, including :

  • Infiltrative disease
  • Venous congestion
  • Portal hypertension
  • Posterior caval syndrome
  • Congestive heart failure

Some of the rare causes of PLE in dogs include :

  • Small intestinal bacterial overgrowth (SIBO)
  • Hypoalbuminaemia causing intestinal mural oedema
  • Increased activation of tissue plasminogen activator
  • Systemic lupus erythematosis (SLE)
  • Chemotherapy or radiotherapy

How is protein losing enteropathy in dogs diagnosed?
If you notice any of the symptoms listed above, consult your veterinarian immediately. Your veterinarian will perform a physical examination and will ask you for a exhaustive history of your frump ’ s health and attack of symptoms you have observed .
In most cases, a combination of the clinical signs, testing ground tests and imaging findings with the analysis of endoscopic intestinal biopsies can lead to at least a probationary diagnosis of PLE and guide initial discussion. however, sometimes a concluding diagnosis is only made after assessing the affected role ’ s answer to discussion .
As it is a syndrome preferably than a disease, once PLE has been confirmed it is substantive to find the underlying lawsuit. Often this can only be accomplished by ruling out early possible causes. Although any intestinal disease that is severe enough to cause a net loss of protein can result in PLE, some diseases are normally recognised to cause PLE, such as :

  • Intestinal lymphangiectasia, characterised by dilation of the intestinal lymph vessels, believed to be the most common cause of PLE in dogs, can occur as a primary (congenital) or secondary (acquired) disease.
  • Inflammatory bowel disease (IBD), defined as chronic inflammation of the bowel wall (e.g., lymphoplasmacytic enteritis), must be severe in order to result in intestinal protein loss.
  • Lymphoma of the intestinal tract can cause hypoalbuminemia, abnormally low levels of albumin, a major blood protein, in 75% of dogs.
  • Adenocarcinoma and other tumours in the intestine may cause PLE due to blood loss and mucosal ulceration.
  • Gastroenteritis (from viral, fungal, or bacterial infections)
  • Stomach ulcers
  • Severe chronic starvation
  • Granulomatous infiltration of the intestines (secondary to fungal infections)
  • Abnormalities of the intestines (from a chronic foreign body, intestinal parasites, an intussusception, haemorrhagic gastroenteritis, etc.)
  • Ulcerative gastroenteritis
  • Hepatic (liver) and renal (kidney) disease

Tests that are typically performed to diagnose PLE and/or rule out other diseases include :
Laboratory tests
Standard testing ground test will be performed, and a preliminary diagnosis of PLE can be made based on low albumin and protein levels in the lineage workplace. Your vet may besides check the blood vitamin levels, which will be depleted if your chase is losing protein from its intestines. Tests probable to be performed are :

  • Complete blood count (CBC) to examine the white and red blood cells and platelets
  • Biochemical profile to examine blood proteins, including albumin and globulin concentrations (which are typically decreased with PLE)
  • Electrolytes to examine the calcium, phosphorous and salt balance
  • Urinalysis to investigate the loss of protein from the kidneys (protein-losing nephropathy) as a possible cause
  • Faecal (stool) examination to check for intestinal parasites, intestinal infections and other indicators that your dog is losing protein from its intestines

Diagnostic imaging
Radiography ( X-rays ) will allow your vet to visually examine your frump ’ south chest and abdomen for internal ulcerations, abnormal accumulation of fluid or tumours. X-rays can be used to rule out evidence of heart disease, fungal infections, cancer or abnormal fluid accretion in the organs or tissues.

sonography of the abdomen may be performed to measure the size of the intestines and look for tell of increase lymph nodes, foreign bodies or cancer. Abdominal sonography can reveal changes to intestinal wall structure, including :

  • Thickening without loss of normal layers (indicative of inflammatory bowel disease)
  • Thickening with loss of layers (indicative of infiltrative intestinal neoplasia)
  • ‘Tiger stripes’, a possible indicator of lymphangiectasia

Abdominal ultrasound may besides reveal an abnormal collection of fluid in the abdomen ( ascites ) or lungs ( pleural effusion ) and mesenteric lymphadenopathy, an inflammation of lymph nodes .

Endoscopy
A humble camera, attached to a tube, is passed through the pawl ’ south mouthpiece and/or anus into the intestines so that the walls of the abdomen and intestinal nerve pathway can be visually examined for ulcers, tissue masses ( tumours ) or abnormalities in the wall or cell structure .
During the endoscopic operation, weave samples can be taken from the stomach, intestines and rectum for biopsy. analysis of biopsied tissue is identical useful for determining why an animal is losing protein through its intestines and can provide a definitive diagnosis of lymphoma and secondary lymphangiectasia .

Surgical exploration
candid abdominal surgery or “ keyhole ” operating room of the abdomen ( laparoscopy ) may be performed to evaluate all the organs and gather multiple, full-thickness biopsies, which may be necessary to rule out certain types of disease like lymphangiectasia .
 

Prognosis

even with aggressive treatment, PLE can dramatically shorten the life anticipation of your dog, and untreated, it can be black. The oklahoman PLE is diagnosed, the better the long-run result. The condition varies in austereness from balmy to severe and prognosis depends on the underlying cause of PLE in each case. however, the long-run prognosis in most dogs is guarded .
As certain breeds show a sensitivity to PLE or related diseases, including yorkshire Terriers, Soft-coated Wheaten Terriers, Basenjis and norwegian Lunehunds, dogs of these breeds showing any of the symptoms of PLE should immediately be examined. Soft-coated Wheaten terriers are known to have a median survival clock time of five months after diagnosis of PLE and of two months if they suffer from coincident protein-losing kidney disease .
prognosis may be worsened by the development of dangerous complications such as pneumonic thromboembolism ( a obstruction in the arteries that supply blood to the lungs caused by blood clots ) and decreased serum albumin assiduity ( hypoalbuminemia ) .
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Treatment for protein losing enteropathy in dogs

As there are many underlie causes of PLE in dogs, there is no single discussion protocol for this syndrome and every affected role has different needs. The remedy aims are to treat the implicit in campaign and to support the patient. In most cases, discussion will be determined by the underlie disease. Your vet will develop a discussion design to help you manage your frank ’ second symptoms, which will include practice and a particular diet to facilitate the absorption of nutrients by your andiron ’ randomness body .
Depending on the implicit in causes of PLE identified by the diagnostic tests, discussion may include :

  • Dietary changes such as a high protein diet for IBD or an ultra-low fat, easily digestible diet for intestinal lymphangiectasia (a dietary trial may be recommended for IBD)
  • Anti-inflammatory medication is the main treatment for IBD but can have unwanted side effects when used at higher doses
  • Procedures to remove the fluid from the chest or abdomen (e.g., thoracocentesis or abdominocentesis)
  • Plasma transfusions to increase plasma volume
  • Intravenous fluids to keep fluid within the blood vessels and help reduce fluid accumulation
  • Diuretics to reduce ascites or pleural effusion
  • Antithrombotic therapy such as low dose aspirin to reduce the risk of thrombosis
  • Dietary supplementation with calcium if a low serum concentration of ionised calcium is detected
  • Anti-emetics to treat nausea
  • Tube feeding, in cases of sever vomiting or unwillingness to eat
  • Synthetic colloids to restore plasma volume
  • Vitamin B12 (cobalamin) injections in cases of low blood concentrations (common in PLE patients)
  • Deworming (for parasitic infections)
  • Antiulcer medication (if gastric ulcers are present)
  • Surgery

Management and long-term care of PLE in dogs:

PLE sufferers are delicate because of their hypoalbuminemia, gastrointestinal disease and their potential to develop ad-lib rake clots. Supportive care is therefore extremely authoritative and providing adequate nutrition is full of life .
regular follow-up examinations and testing will be required, including complete blood counts and biochemical profiles to check that your cad ’ s rake protein horizontal surface is stable and not becoming perilously depleted. Your vet will besides check your frump for symptoms such as breathing difficulties fluid built up in the abdomen .
 

In a nutshell

Any intestinal disease, if severe adequate, can result in protein losing enteropathy ( PLE ) in dogs. The underlie cause of PLE is disruption of the intestinal lining, leading to the abnormal loss of protein from the intestines. Because a number of diseases can lead to this condition, PLE is classified as being a syndrome preferably than a disease .
As there are a diverse image of implicit in conditions that cause PLE, it may develop in dogs of any age, breed, or arouse. however, some breeds have been demonstrated to be peculiarly at risk ; these include yorkshire Terriers, Soft Coated Wheaten Terriers, norwegian Lundehunds, and Basenjis .
many dogs with PLE have non-specific signs of gastrointestinal disease, however, the most common clinical signs are diarrhea, vomiting, and weight loss. Diagnosis entails blood screen and other fact-finding tests to determine the implicit in disease that may have caused the PLE. In general, treatment of PLE is determined by the fundamental disease and the badness of the clinical signs. Modified nutriment is broadly a contribution of the ongoing management of PLE. In some cases, the primary, fundamental disease may not be treatable but even where aggressive treatment is undertake, the long-run prognosis in most dogs with PLE is guarded .

More information

hypertext transfer protocol : //www.petmd.com/dog/conditions/digestive/c_dg_protein_losing_enteropathy
hypertext transfer protocol : //www.pethealthnetwork.com/dog-health/dog-diseases-conditions-a-z/protein-losing-enteropathy-ple-dogs
hypertext transfer protocol : //veterinarycalendar.dvm360.com/care-dogs-with-protein-losing-enteropathy-proceedings
hypertext transfer protocol : //en.wikipedia.org/wiki/Protein_losing_enteropathy
hypertext transfer protocol : //vcahospitals.com/know-your-pet/proteinlosing-enteropathy-ple-in-dogs

hypertext transfer protocol : //www.bli.uci.edu/conti2013/Gaschen_text.pdf
hypertext transfer protocol : //en.wikivet.net/Protein_Losing_Enteropathy
hypertext transfer protocol : //www.wheatenhealthinitiative.com/Pages/hereditplepln.html

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