Canis ISSN: 2398-2942

Protein-losing enteropathy

Contributor(s): Ken Harkin, Craig Ruaux

Introduction

  • Excessive loss of proteins into the gut → hypoproteinemia.
  • Cause: primary intestinal pathology.
  • Signs: diarrhea (sometimes), edema, weight loss.
    • Diarrhea typically variable, soft, poorly formed stools.
    • Gastrointestinal signs show waxing/waning course.
  • Diagnosis: signs, hypoproteinemia, intestinal biopsy.
  • Treatment: symptomatic. Directed at underlying pathology.
  • Prognosis: guarded.

Pathogenesis

Etiology

Increased intestinal permeability

  • Villous atrophy.
  • Intestinal infiltration:
  • Parasitic intestinal disease.
  • Intestinal fungal or parasitic infection (histoplasmosis Histoplasmosis , tricuriasis, ancylostomiasis).
  • Small intestinal bacterial overgrowth Antibiotic-responsive diarrhea (ARD).
  • Phycomycosis in Gulf Coast States of US.
  • Intestinal bleeding, eg neoplasia, ulceration, coagulopathy:
    • Foreign body.
    • Chronic intussusception Intussusception.
    • Acute or chronic bacterial enteritis.
  • Immune-mediated and allergic disease.

Reduced lymphatic drainage

  • Lympangiectasia:
    • Congenital.
    • Acquired.

Pathophysiology

  • Loss of albumin via intestine exceedssynthesis → hypoproteinemia.
  • Defective lymphatic drainage → ruptured lymph ducts → protein carried in lymph lost into gut lumen.
  • Protein lost in the gut is normally digested and reabsorbed.
  • If protein loss increases, or reuptake is reduced, then protein is lost from body in feces.
  • Hypoproteinemia → peripheral edema, ascites, pleural effusion.

Timecourse

  • Insidious onset.
  • Weeks to months.

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Mellanby R J, Mellor P J, Roulois A, Baines E A, Mee A P, Berry J L & Herrtage M E (2005) Hypocalcaemia associated with low serum vitamin D metabolite concentrations in two dogs with protein-losing enteropathies. JSAP 46 (7), 345-351 PubMed.
  • Ruaux C G et al (2004) Protein-losing enteropathy is associated with reduced fecal proteolytic activity in dogsVet Clin Pathol 33 (1), 20-22 PubMed.
  • Littman M P et al (2000) Familial protein-losing enteropathy and protein-losing nephropathy in Soft Coated Wheaten Terriers - 222 Cases (1983-1997). J Vet Intern Med 14 (1), 68-80 PubMed.
  • Vaden S L et al (2000) Food hypersensitivity reactions in Soft Coated Wheaten Terriers with protein-losing enteropathy or protein-losing nephropathy or both - gastroscopic food sensitivity, dietary provocation and fecal immunoglobulin E. J Vet Intern Med 14 (1), 60-67 PubMed.
  • Suter M M, Palmer D G, Schenk H (1985) Primary intestinal lymphangiectasia in three dogs: a morphological and immunopathological investigation.​ Vet Pathol 22 (2), 123-130 PubMed.


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