Protein-Losing Enteropathy: The Invisible Challenge for Our Furry Friends.

What is PLE (Protein-losing Enteropathy)?

Protein-Losing Enteropathy (PLE) in dogs is a condition where your dog's body loses too much protein through its digestive system, usually from the intestines. Proteins like albumin are important for keeping fluids in the right places in the body, supporting the immune system, and overall health. When too much protein is lost, it can cause serious problems.

Viggo's case of PLE and his journey with our Emergency and Critical Care team

Viggo was referred to our emergency and critical care department for stabilization and further work up after being assessed to be very ill by his primary care veterinarian. Viggo's owners also mentioned that he had a history of vomiting once to twice a month.

He had been inappetant, lethargic, urinating with blood and vomiting. He presented very quiet, dull and with a bloated-looking stomach.

Diagnostics and Assessments

FAST scans during initial physical exam - Bicavitary Effusions
TFAST scan showed scant pleural effusion in his chest
AFAST scan showed copius amount of free fluid in his abdominal cavity in all quadrants (which is what resulted in his bloated belly)

In dogs with PLE, the loss of important proteins from their digestive system causes their blood protein levels to drop. This makes it harder for the body to keep fluids in the right places, causing fluid to leak into the abdomen and chest. This can lead to swelling in the belly and trouble breathing. This condition, called bicavitary effusions, is a serious problem that needs medical attention, like draining the fluid or treating the underlying cause of protein loss.

Urine sampling for UPC ratio shows proteinuria (presence of excess protein in the urine).

Normally, proteins like albumin are not found in significant amounts in urine because the kidneys filter out waste but keep important proteins in the bloodstream. However, when a dog has PLE, it may experience protein loss not only through the gastrointestinal tract (as in PLE) but also through the kidneys, resulting in proteinuria.

Initial blood work shows,
- Hypoproteinemia (low protein levels)
- Hypoalbuminaemia (low albumin levels)
- Hypocalcaemia (low calcium levels)
- Elevated BUN (high blood urea nitrogen levels)

Full abdominal ultrasound with our sonographer Liz the following day revealed mucosal striations through large portions of jejunum, with most other findings most consistent with PLE.

Viggo also started developing oedema on his face, ventral neck and extremities.

Dogs with PLE get swelling in their face and legs because they lose too much protein, especially albumin, which helps keep fluid inside their blood vessels. When protein levels drop too low, the blood vessels can’t hold onto fluid properly, causing it to leak into the tissues, leading to swelling. This swelling tends to show up in areas like the face and legs because gravity pulls the fluid down.

What are other symptoms commonly seen on a patient with PLE?

Weight loss: Despite eating normally or even more, the dog may lose weight.
Diarrhea: Frequent, watery stools are common.
Vomiting: Dogs may vomit regularly due to gastrointestinal issues.
Swelling (edema): Fluid buildup in the abdomen (ascites) or in the legs and face, leading to noticeable puffiness or bloating.
Lethargy: The dog may become weak, tired, or less active than usual.
Poor coat condition: The dog’s fur may look dull, dry, or thin.
Increased thirst: Drinking more water than usual, which can be a sign of dehydration.
Appetite changes: Some dogs may eat more, while others may lose interest in food.

These symptoms can vary based on the severity of the condition and how advanced it is.

Viggo's Road to Recovery

For Viggo’s case, while treatment for his gastrointestinal signs such as vomiting, nausea and diarrhoea were started, a nasogastric tube feeding on a high protein low fat diet was also started immediately in attempts to bring his protein levels up.

His condition required constant monitoring to assess his losses, organ functions and clinical signs for treatments rendered to be tweaked and managed. At one point, Viggo had to be given human serum albumin transfusion due to his inability to maintain intravascular volume in his body.

The team was overjoyed when Viggo started to be more keen to take walks and also started taking solids on his own!

Viggo was discharged home with continued supportive medications and diet. Along with Viggo’s owner’s commitment and dedication for the nursing support Viggo requires, he came back for a review with us a different boy!