Intestinal Lymphangiectasia is an obstructive disorder that results in dilated lymph vessels or lacteals. This disorder is one of the four chief cases of protein-losing enteropathy by which proteins are lost through the pet’s intestinal tract.
An inflammation applies back pressure on the lymph vessels causing them to dilate. Inflammation in the intestine or local structures may block the lymph flow. These lacteals absorb nutritional fat. When these lacteals burst, the valuable lymph, cells, fats and protein are lost. Within the gastrointestinal tract, this disorder causes profoundly low protein levels (enteropathy) in dogs. If this case is a widespread intestinal disease, the result may be nutritional loss.
Primary or congenital causes may be varied: focal (intestinal only) Lymphangiectasia; diffuse (widespread) lymphatic abnormalities; chylothorax (collection of high fat lymphatic fluid in chest cavity); lymphedema (swelling); chylous ascites (collection of high fat lymphatic fluid in abdominal cavity); and thoracic duct obstruction.
Symptoms and Diagnosis
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.
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 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.