Lymphangiectasia in Dogs
Overview of Canine Lymphangiectasia
Lymphangiectasia is an obstructive disorder characterized by marked dilation and dysfunction of the intestinal lymphatic system. This disorder affects the gastrointestinal tract, resulting in a protein-losing enteropathy, and eventually, profoundly low blood protein levels develop. Impaired intestinal lymph drainage is presumably caused by obstruction to the normal flow.
Primary or Congenital Causes of Lymphangiectasia in Dogs Focal (intestinal only) lymphangiectasia Diffuse (widespread) lymphatic abnormalities Chylothorax (collection of high fat lymphatic fluid in the chest cavity) Lymphedema (swelling of any part of the body due to insufficient lymphatic drainage) Chylous ascites (collection of high fat lymphatic fluid in the abdominal cavity) Thoracic duct obstruction (blockage of the lymphatic system that drains the chest cavity)
Secondary Causes of Lymphangiectasia in Dogs Right heart failure Constrictive pericarditis (covering of the heart cannot expand) Budd-Chiari syndrome (blockage of the liver veins) Cancer
The average age of onset is 5 years of age, however this disorder can be seen in older or younger dogs. There appears to be a slight increased incidence in females over males. Although lymphangiectasia can affect all breeds, dogs with a familial predisposition include soft-coated Wheaten terriers, basenjis, Lundehunds and Yorkshire terriers.
Although some patients may be asymptomatic (have no clinical signs), some may have life threatening manifestations of lymphangiectasia.
What to Watch For
Symptoms of Lymphangiectasia in Dogs may include: Diarrhea Anorexia Lethargy Weight loss Vomiting Flatulence Ascites (fluid in the abdominal cavity) Edema (abnormal fluid accumulation in any part of the body) Respiratory difficulty secondary to pleural effusion (fluid in the chest cavity)
Diagnosis of Lymphangiectasia in Dogs Complete blood cell count (CBC) Biochemical profile Urinalysis Fecal examinations Chest and abdominal X-rays Abdominal ultrasound Gastroduodenoscopy
Treatment of Lymphangiectasia in Dogs Dietary management is often recommended and one of the most important parts of therapy. Oncotic agents like plasma, dextrans, hetastarch help maintain normal fluid distribution in the body and may be of benefit in critical cases that are severely hypoproteinemic and need immediate attention. Corticosteroids (anti-inflammatory drugs)
Home Care and Prevention
Administer all medication and dietary recommendations as directed by your veterinarian. Follow up as directed. If your dog’s condition is not improving or is getting worse, seek veterinary attention at once.
There is no preventative care for protein losing enteropathy.
In-depth Information on Lymphangiectasia in Dogs
Lymphangiectasia is the blockage of lymphatic vessels that carry lymph fluid through the body. It is the most common intestinal disease that causes low protein levels in dogs. Although most often a primary intestinal disorder, it is interesting to note that gastrointestinal signs (vomiting, diarrhea) are not present in all cases, and the clinical signs are quite varied, ranging from mild non-specific intermittent signs, to profound weight loss, emaciation and in some cases, life-threatening respiratory difficulty secondary to pleural effusion (fluid accumulation in the chest cavity). The initial step in the diagnosis of lymphangiectasia is to exclude non-intestinal causes of hypoproteinemia, specifically related to the liver or kidneys, and then to rule out other intestinal disorders that cause hypoproteinemia.
Many disorders must initially be considered: Severe liver disease must be eliminated as a contributing cause of hypoproteinemia. Examples include hepatitis (inflammation of the liver), cancer and cirrhosis (end stage liver disease). Protein-losing nephropathy (kidney disorders) need to be considered in hypoproteinemic patients. Glomerulonephritis is an inflammation of a part of the kidney. Amyloidosis is the deposition or collection of a type of protein in organs and tissues that compromise their normal function. Blood loss for any reason will decrease the protein level in addition to causing anemia. Inadequate protein intake or starvation will contribute to hypoproteinemia. Congestive heart failure may be associated with hypoproteinemia, specifically constrictive pericarditis, which is a condition where the tissue covering the heart cannot expand for a variety of reasons. Lymphoplasmacytic enteritis is a form of inflammatory bowel disease characterized by the infiltration of cells into the intestinal wall, causing a disruption of normal intestinal function and protein loss. Intestinal cancer of any kind may cause or contribute to protein loss in the gut. Lymphosarcoma is a malignant cancer that is the most common cancer causing protein loss into the gut. An intussusception (telescoping of part of the bowel into an adjacent segment of bowel), especially chronic, can cause protein loss. Chronic foreign bodies of the intestinal tract are often associated with a number of gastrointestinal signs (diarrhea, vomiting, weight loss) and occasionally hypoproteinemia. Ulcerative gastroenteritis, or interruptions in the lining of the gastrointestinal tract, may cause anemia and hypoproteinemia. It may be secondary to inflammation, drug administration, cancer or foreign bodies. Small intestinal bacterial overgrowth (SIBO) is characterized by an overgrowth of normal intestinal flora (bacteria) usually secondary to various gastrointestinal diseases, but occasionally as a primary entity. Histoplasmosis is a fungal infection that affects many systems, including the gastrointestinal tract. It has been associated with profound hypoproteinemia. Intestinal parasitism has been associated with protein-losing enteropathy, especially in young pups that are anemic as well. Common parasites include roundworms, hookworms, whipworms, coccidia and giardia. Food allergies and gluten-induced enteropathy (sensitivity to a component of wheat and other grains), have been associated with hypoproteinemia.