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Protein-losing enteropathy
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.
Presenting signs
- History of chronic diarrhea but occasionally this is not seen.
- Peripheral edema, ascites, or hydrothorax (hypoproteinemia Hypoproteinemia and hypoalbuminemia).
- Non-specific signs such as vomiting Vomiting and anorexia.
- Signs of concurrent hemorrhagic anemia (depression and pallor).
Cost considerations
- This is a serious complication of a serious disease and to make a diagnosis will involve a significant cost.
- Therapy is often lifelong and may be very involved if treatment for gastrointestinal lymphoma is undertaken.
Special risks
- Hypoproteinemia and hypoalbuminemia alter the pharmacokinetics of many medications including agents used for sedation and anesthesia.
- Hydrothorax will increase the anesthetic risk.
- Concurrent debilitation or anemia will increase an anesthetic risk.
- Increased risk of wound breakdown following biopsy in severely hypoproteinemic or debilitated patinets.
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 4 (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.