Protein Losing Enteropathy in Dogs (PLE)

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Overview of Canine Protein Losing Enteropathy (PLE)

Protein losing enteropathy (PLE) is a nonspecific term referring to conditions associated with excessive loss of plasma proteins into the gastrointestinal tract. There are numerous causes in dogs lymphatic disorders and mucosal diseases. Details of these conditions are below including:

Disorders of Lymphatic System

  • Intestinal lymphangiectasia, or blockage of the lymphatics of the gastrointestinal tract
  • Cancer
  • Congestive heart failure
  • Granuloma (a non-cancerous mass of tissue) of the small intestines or the tissue that attaches abdominal organs to the body wall
  • Diseases Associated with Increased Mucosal Permeability:

    (Increased mucosal permeability is the passage of fluid through tissue.)

  • Lymphoplasmacytic enteritis, a type of inflammatory bowel disorder
  • Intestinal cancer
  • Intussusception, which is telescoping of one part of the bowel into an adjoining segment
  • Chronic intestinal foreign body
  • Ulcerative gastroenteritis
  • Histoplasmosis (fungal infection)
  • Intestinal parasitism
  • Immune-mediated diseases
  • Hemorrhagic gastroenteritis (HGE) is a disorder with no known cause. It has a predilection for small breed dogs, and it is not recognized in cats. HGE is characterized by the sudden onset of profuse bloody diarrhea and occasional vomiting

    PLE is seen in both dogs and cats. PLE can be seen in any age animal and equally in both genders. Although PLE affects all breeds, dogs with familial predisposition to lymphangiectasia (the most common cause of PLE) 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 PLE.

  • What to Watch For

  • Diarrhea
  • Anorexia
  • Lethargy
  • Weight loss
  • Ascities (fluid in the abdominal cavity)
  • Edema (abnormal fluid accumulation in any part of the body)
  • Respiratory difficulty secondary to fluid in the chest cavity
  • Diagnosis of Protein Losing Enteropathy in Dogs

  • Complete blood cell count (CBC)
  • Biochemical profile
  • Urinalysis
  • Fecal examinations
  • Chest and abdominal X-rays
  • Abdominal ultrasound
  • Gastroduodenoscopy
  • Treatment for Protein Losing Enteropathy in Dogs

    Treatment of patients with PLE should be directed at the underlying cause. Most of these individuals can be treated as outpatients.

  • Dietary management is often recommended and varies depending on the underlying cause.
  • MCT oil is a source of calories that is well tolerated by patients with PLE that may be indicated in patients who are severely emaciated.
  • Fluid therapy may be necessary in some patients with severe vomiting and diarrhea, and is directed toward correction of dehydration and acid-base derangements, replacement of electrolyte deficits and to provide for ongoing losses.
  • Diuretics that help remove excess fluid from the body may be indicated in some patients with PLE.
  • Oncotic agents help maintain normal fluid distribution in the body.
  • Antibiotic therapy, anti-inflammatory drugs, and/or antifungal agents may be indicated depending on the underlying cause of PLE.
  • 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 and is getting worse, seek veterinary attention at once. There is no preventative care for protein losing enteropathy.

    Information In-depth on Protein Losing Enteropathy in Dogs

    The term protein losing enteropathy (PLE) refers to a variety of intestinal diseases that are associated with hypoproteinemia (low protein levels) caused by an excessive loss of protein into the gut. It is important to note that the initial step in the diagnosis is to exclude non-intestinal causes of hypoproteinemia, specifically related to the liver or kidneys.

    Many different disease processes can cause or are associated with PLE. The clinical signs seen 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 fluid accumulation in the chest cavity. Many disorders must be considered initially. These disorders in dogs include liver disease, kidney lymphatic disease, and gastrointestinal disease. Details below include: 

    Liver Disease

    Severe hepatic disease must be ruled out as a contributing cause of hypoproteinemia. These include:

  • Hepatitis (inflammation of the liver)
  • Cancer
  • Cirrhosis
  • Kidney Disease

    Protein losing kidney disorders need to be considered in hypoproteinemic patients. These include:

  • Glomerulonephritis, an type of kidney inflammation involving the glomeruli, which are a mass of capillaries
  • Amyloidosis, the deposition or collection of a type of protein in organs and tissues that compromises their normal function
  • Lymphatic Diseases

    Disorders of the lymphatic system need to be considered. These include:

  • Intestinal lymphangiectasia – blockage of the lymphatics of the gastrointestinal tract – is one of the most common causes of PLE.
  • Cancer of any sort must be ruled out. Lymphosarcoma is a malignant cancer that is the most common cancer causing PLE. It most often takes the form of a microscopic infiltration into the bowel, although it may form mass lesions.
  • Granuloma, a non-cancerous mass of tissue, of the small intestines or tissue that attaches abdominal organs to the body wall may be associated with profound protein loss.
  • Congestive heart failure may be associated with hypoproteinemia. Constrictive pericarditis is a condition where the tissue covering the heart cannot expand for a variety of reasons.
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