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Lymphangiectasia

Issue Description
Lymphangiectasia is an intestinal disease of dogs, and more rarely humans, characterized by lymphatic vessel dilation, chronic diarrhea and loss of proteins such as serum albumin and globulin. It is considered to be a chronic form of protein-losing enteropathy.
Other Names
Intestinal Lymphangiectasia



Causes
The most common cause of lymphangiectasia is congenital malformation of the lymphatics. Secondary lymphangiectasia may be caused by granulomas or cancer causing lymphatic obstruction, or increased central venous pressure (CVP) causing abnormal lymph drainage. Increased CVP can be caused by pericarditis or right-sided heart failure. Inflammatory bowel disease can also lead to inflammation of the lymphatics and lymphangiectasia through migration of inflammatory cells through the lymphatics.

Affected Breeds
Breeds commonly affected by lymphangiectasia and/or protein-losing enteropathy include the Soft-Coated Wheaten Terrier, Norwegian Lundehund, Basenji, and Yorkshire Terrier.

Symptoms
The symptoms of this intestinal disorder include weight loss, chronic diarrhea, vomiting and bloating from fluid accumulation in the abdomen. Not all cases present symptoms of diarrhea and vomiting. Clinical signs can vary from mild signs, lethargy, flatulence, edema to emaciation. In some cases fluid accumulation in the chest (pleural effusion) may lead to the secondary symptoms of life-threatening respiratory difficulty.

Diagnosis
Blood test results can help diagnose Intestinal Lymphangiectasia, especially if no clues of the condition are present. Results can show a low lymphocyte count, low cholesterol and low albumin level. The albumin is the main blood protein that transports biochemicals. The albumin keeps water in the bloodstream. If the vasculature no longer holds the water, the leakage causes fluid accumulation in the tissue, chest or abdomen. A biochemical profile can help determine kidney, liver, protein and electrolyte status. Urinalysis is often normal and can rule out kidney disease. Other tests include fecal exams, chest and abdominal x-rays, abdominal ultrasound and gastroduodenoscopy. The veterinarian may conduct an intestinal biopsy either through surgery or endoscopy to determine cause and treatment.

Treatment
Treatment of Intestinal Lymphangiectasia can include treating the inflammation, dietary management and diuretics, oncotic agents, and other options, including surgery. Treatment varies with consideration of the type of signs and severity of the disorder. Pets suffering from severe vomiting and/or diarrhea may receive aggressive treatment and stabilization in a hospital. Patients with milder signs may receive close monitoring and treatment as outpatients.

Veterinarians may treat inflammation with corticosteroids, anti-inflammatory drugs, such as prednisone and/or azathioprine. Dietary management can help reduce pressure in the lymph vessels to reduce lymph. The diet can include adding medium chain triglycerides oil (MCT) to provide a source of calories with a low fat diet. Diuretics can increase urination and reduce fluid accumulation. Tapping the body cavity and suctioning the fluid is another option. Oncotic agents (plasma, dextrans, hetastarch) help with the normal fluid distribution.

Follow-up can include signs of activity level, body weight, appetite and clinical signs of pleural effusion, ascites and edema. Tests can include serum protein level.


Follow Up
Unfortunately, this condition isn't something that can be prevented. Managing the condition once it occurs is the only option.

Limit exercise while your canine is recovering. Encourage him to rest as much as possible. Keeping him on a leash during bathroom breaks can help cut down on excess activity.