Lymphangiectasia

Description:

Lymphangiectasia is a type of intestinal disorder that affects dogs of any age and breed, There are tiny lymphatic vessels within the small intestine that are important in absorbing nutrients from the intestinal tract. In lymphangiectasia, these lymphatics become atrophied (shriveled up) or plugged with abnormal cells such as white blood cells or cancer cell. When this happens, the body is deprived of proteins, fats and fat-soluble vitamins. This in turn, also causes abnormal levels of hormones and blood clotting factors.

Diagnosis:

Dogs with this disease may not initially have any obvious signs, but as the disease progresses, they can develop diarrhea, vomiting, decreased appetite, fluid accumulation in the abdomen or chest, swelling of the limbs and thromboembolic disease.

There are typical changes seen on blood tests including low protein levels, low cholesterol and low white blood cells called lymphocytes. These changes are not specific for the disease, but when they are present, we begin to suspect that lymphangiectasia is present. Additional diagnostics include ultrasound to examine the appearance of the intestinal tract which is often thickened and has a striped appearance. An endoscopy is required to definitively diagnose this disorder. Endoscopy is performed under general anesthesia rather than sedation which is typical in people. The remainder of the procedure is just like an endoscopy in a person. A long tube with a light and a camera at the end is inserted through the mouth into the stomach and upper small intestine. Often, it is recommended to also direct the endoscopy up through the colon and into the lower small intestine. Many small surface biopsies are obtained along the length of the examined intestinal tract.

Treatment:

Treatments may include an ultra-low fat diet. This needs to be a prescription formula or a home cooked diet developed by a boarded veterinary nutritionist. If concurrent inflammatory bowel disease (IBD) is present and causing white blood cells to plug the lymphatics, treatment for IBD will also be initiated. This may include steroids and other immunosuppressive medications to normalize an otherwise overactive immune system. Sometimes concurrent lymphoma, a type of intestinal cancer is diagnosed. There are many options for palliative treatment for lymphoma. If infection is found, specific therapy against the infection can be quite effective.

Prognosis:

Prognosis depends on the severity of disease and whether the lymphangiectasia is primary or secondary to other disorders such as IBD, cancer or infection. While primary lymphangiectasia and disease secondary to cancer may be more resistant to treatment, most dogs respond well to therapy, especially when IBD or infection are appropriately treated.

Author: Andrea Wells, DVM, DACVIM, Advanced Veterinary Specialists