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Protein-Losing Enteropathy - Coggle Diagram
Protein-Losing Enteropathy
loss of proteins through GI tract
mechanisms
physical or fxn'l lymphatic obstruction
lymphangiectasia
marked dilation and dysfunction of intestinal lymphatics
rupture of lacteals
leakage of protein-rich lymph
irritating
inflammation
granuloma formation
can be primary or secondary
lymphangitis
mucosal injury
inflammatory
neoplastic
infiltrate
infectious
hookworms
extremely rare in cats
CS
vomiting
diarrhea
small bowel diarrhea most common
inappetence
cachexia
weight loss
abdo distension/ascites
dyspnea/tachypnea/pleural effusion
diagnostics
tier 1
CBC
chem
hypoalbuminemia
selective
inflammation (negative acute phase)
liver failure
PLN
Addison's disease
starvation/cachexia
nonselective
PLE
hemorrhage
burns
third space
hypoglobulinemia
hypocholesterolemia
hypocalcemia
Ca is carried on albumin
hypoglycemia is rare
UA
necessary to ensure there is not a concurrent PLN
fecal
baseline cortisol
esp Addison's :dog:
chest and abdo rads
effusion
mets in chest
tier 2
abdo US
GI panel
B12
folate
TLI
PLI
bile acids
ACTH stimulation
Addison's suspects
only if baseline cortisol is <2ug/dL
a1 protease inhibitor quantification in feces
plasma protein lost into GI tract similar rate to albumin
resists degredation
collect fresh feces on 3 consecutive days
tier 3
CT
endoscopy
abdominal explore
treatment
if due to IBD
hydrolyzed diet
ultra low fat diet for lymphangietasia
if ascites
furosemids/spironolactone
centesis
prognosis
50% mortality
median survival times highly variable
complications such as thromboembolism increase mortality
coagulability
antithrombin III is lost in GI tract
PLE results in hyper coagulability
clot formation risk
antithrombotic treatment recommended
clopidogrel
low dose aspirin