Dr. Bari Spielman
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. 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).
Many disorders must initially be considered:
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.