Felis ISSN 2398-2950

Protein-losing enteropathy

Synonym(s): PLE

Contributor(s): Marge Chandler, David Godfrey, Kenneth Simpson

Introduction

  • Protein-losing enteropathies are rare in cats.
  • When they do occur it is more common to detect changes in protein metabolism on biochemistry rather than symptoms of hypoproteinemia.
  • Cause: likely to occur in association with more serious underlying diseases.
  • There must be a high index of suspicion for intestinal lymphoma or severe IBD.
  • Signs: chronic diarrhea, ascites, vomiting, pallor.
  • Diagnosis: history, signs, biochemistry, urinalysis, radiography, endoscopy.
  • Treatment: of underlying cause; fluid drainage.
  • Prognosis: depends on underlying cause.

Pathogenesis

Etiology

  • Chronic intussusception Intussusception (usually in association with hemorrhagic anemia).
  • In theory the following diseases might cause a protein-losing enteropathy:
    • Viral and bacterial enteritis.
    • Suppurative and granulomatous enteritis.
    • Parasites especially Hookworm and histoplasmosis Histoplasma capsulatum.
  • Intestinal lymphoma Lymphoma.
  • Inflammatory bowel disease Inflammatory bowel disease: overview - some cats have hypoalbuminemia and normal or high globulins. Most cases are reported with lymphocytic-plasmacytic enteritis Lymphocytic / plasmacytic enteritis or eosinophilic enteritis Gastroenteritis but this may reflect that these are more common diseases.
  • Cats almost never develop intestinal lymphangiectasia.

Pathophysiology

  • Intestinal disease   →   increased gastrointestinal mucosal permeability to proteins.
  • Bleeding lesions also will result in hypoproteinemia Hypoproteinemia.
  • Increased pressure in the intestinal lymphatic from any cause (congenital defect, obstruction from mass, liver disease or right-sided heart failure).
  • Normal intestinal capillaries have relatively large fenestrations to allow for the absorption of proteins and the mucosal integrity is important in preventing intestinal protein loss.
  • In the classic protein-losing enteropathy both albumin and globulins are lost equally and are reduced in proportion in the serum biochemistry results.
  • Hypoproteinemia, especially hypoalbuminemia   →   decreased blood oncotic pressure   →   clinical signs of protein-losing enteropathy-peripheral edema, ascites and hydrothorax.

Timecourse

  • Weeks to years.

Diagnosis

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Treatment

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Prevention

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Simpson K W, Fyfe J, Cornetta A et al (2001) Subnormal concentrations of serum cobalamin (vitamin B12) in cats with gastrointestinal disease. JVIM 15 (1), 26-32 PubMed.
  • Fondacaro J V, Richter K P, Carpenter J L et al (1999) Feline gastrointestinal lymphoma: 67 cases (1988-1996). Eur J Comp Gastroenterol (2), 5-11 VetMedResource.
  • Hart H R, Shaker E, Patnaik A K et al (1994) Lymphocytic-plasmacytic enterocolitis in cats - 60 cases (1988-1990). JAAHA 30 (5), 505-514 VetMedResource.
  • Jergens A E (1992) Feline inflammatory bowel disease. Comp Cont Ed Pract Vet 14 (4), 509-518 VetMedResource.

Other sources of information

  • Bush B M (1991) Interpretation of laboratory results for small animal clinicians. Blackwell Scientific Publications, Oxford. ISBN 0-632-03259-6.
  • Guilford W G, Center S A and Strombeck D R (1996) Strombeck's Small Animal Gastroenterology. Saunders, Philadelphia. ISBN 0-721637604.
  • Tams T (1991) Inflammatory bowel disease. In: Consultations in Feline Internal Medicine. Ed August J R. W B Saunders, Philadelphia pp 409-411. ISBN 0-7216-226-7.


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