Intestinal lymphangiectasia

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Classic presentation of a Beagle with pot-bellied appearance associated with intestinal lymphangiectasia[1]

Intestinal lymphangiectasia is a heterogenous inflammatory bowel disease characterized by a protein-losing enteropathy[2].

This disease has been reported as a prequel to hypomagnesemia and secondary hypoparathyroidism with resultant lymphocytic-plasmacytic enteritis[3].

Clinically affected dogs are usually large-breed dogs such as the Rottweiler and Norwegian Lundehund[4]. In the Lundehund, a higher incidence of gastric carcinoma and gastritis is associated with this disease[5].

Symptoms which are commonly observed include chronic weight loss, intermittent anorexia, vomiting and diarrhea. Other promodromal signs include dehydration, ascites and pain on palpation of the abdomen[6].

This disease may be multifactorial in origin as some dogs present with lymphocytic-plasmacytic enteritis and pancreatic exocrine insufficiency[7].

Hematological examination may reveal characteristic hypoalbuminemia, hyperglobulinemia, lymphopenia, hypocalcemia, and hypercholesterolemia. Postprandial bile acids values should be evaluated to eliminate possible hepatic causes of gastrointestinal disease.

Radiography is usually unrewarding, but endoscopy may show peritoneal effusion, thickening of intestinal loops as well as corrugations[8], irregular small intestinal masses[9] and hyperechoic mucosal striations[10].

Intestinal biopsies are usually recommended, often obtained during an exploratory laparotomy in order to histologically examine samples for a definitive diagnosis. Histologically, the characteristic feature of this disease is markedly dilated lymph vessels in the intestinal villi of the intestine[11].

A differential diagnosis would include other causes of inflammatory bowel disease, intestinal lymphoma, gastrointestinal stromal tumor, gastrointestinal parasites such as Giardia spp and yeast infections with Cyniclomyces guttulatus[12].

Treatment is usually symptomatic with antidiarrheal medication, dietary modification, prednisolone[13] and anthelmintic therapy.

A dietary change to reduce long-chain triglycerides in the diet is thought to reduce loss of lymph to the gastrointestinal lumen through reduced chylomicron formation[14]. There is some evidence that long-chain triglycerides may be proinflammatory, which could also stimulate the loss of lymph from inflamed lacteals. It has been reported that reducing the presence of long-chain triglycerides in the diet can decrease lymph flow ten-fold in the mesentery[15].

With correct treatment, many dogs respond and clinical symptoms resolve. Long-term prednisolone may be required to maintain good quality of life and abeyance of clinical disease.

References

  1. Brooks TA (2005) Case study in canine intestinal lymphangiectasia. Can Vet J 46(12):1138-1142
  2. Larson RN et al (2012) Duodenal endoscopic findings and histopathologic confirmation of intestinal lymphangiectasia in dogs. J Vet Intern Med 26(5):1087-1092
  3. Bush WW et al (2001) Secondary hypoparathyroidism attributed to hypomagnesemia in a dog with protein-losing enteropathy. J Am Vet Med Assoc 219(12):1732-1734
  4. Berghoff N et al (2007) Gastroenteropathy in Norwegian Lundehunds. Compend Contin Educ Vet 29(8):456-465
  5. Kolbjørnsen O et al (1994) Gastropathies in the Lundehund. I. Gastritis and gastric neoplasia associated with intestinal lymphangiectasia. APMIS 102(9):647-661
  6. Kull PA et al (2001) Clinical, clinicopathologic, radiographic, and ultrasonographic characteristics of intestinal lymphangiectasia in dogs: 17 cases (1996-1998). J Am Vet Med Assoc 219(2):197-202
  7. Rodríguez-Alarcón CA et al (2012) Protein-losing enteropathy in a dog with lymphangiectasia, lymphoplasmacytic enteritis and pancreatic exocrine insufficiency. Vet Q 32(3-4):193-197
  8. Moon ML et al (2003) Ultrasonographic appearance and etiology of corrugated small intestine. Vet Radiol Ultrasound 44(2):199-203
  9. Louvet A & Denis B (2004) Ultrasonographic diagnosis - small bowel lymphangiectasia in a dog. Vet Radiol Ultrasound 45(6):565-567
  10. Sutherland-Smith J et al (2007) Ultrasonographic intestinal hyperechoic mucosal striations in dogs are associated with lacteal dilation. Vet Radiol Ultrasound 48(1):51-57
  11. Kleint M (1994) Intestinal lymphangiectasis in the dog. A literature review with a case history. Tierarztl Prax 22(2):165-171
  12. Dijkstra M et al (2010) Protein-losing enteropathy in Rottweilers. Tijdschr Diergeneeskd 135(10):406-412
  13. Steiner JM (2004) Protein-losing enteropathy. In: Tilley LP, Smith FWK, eds. The 5-Minute Veterinary Consult Canine and Feline, 3rd ed. Philadelphia: Lippincott Williams & Wilkins. pp:1070–1071
  14. Hand MS & Novotny BJ (2002) Pocket Companion to Small Animal Clinical Nutrition, 4th ed. Topeka, Kansas: Mark Morris Institute. pp:640–646
  15. Melzer KJ (2002) Canine intestinal lymphangiectasia. Compend Contin Educ Pract Vet 24:953–961
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