By Dr. Becker
Today we're going to discuss the disease called lymphangiectasia. Lymphangiectasia means "dilated lymph vessels." The disease is characterized by significant dilation and dysfunction of the intestinal lymph system.
Lymph is fluid that travels throughout the body. But instead of being pumped by the heart like blood, it moves as a result of normal muscle activity.
Lymphangiectasia Is the Result of Inflammation
Lymph is made up of cells of the immune system called lymphocytes. The cause of lymph vessel dilation is typically inflammation that puts pressure on the vessels, causing them to enlarge. Lymph flow can be blocked by the inflammatory response.
There are special lymph vessels in the intestines called lacteals. Their job is to absorb fats from food. When lymph vessels are dilated and under pressure, the lacteals rupture, and the lymph, cells, fats, and all-important proteins inside them are lost. The intestine may reabsorb some of these substances, but if the inflammatory process is widespread, the net result is loss of nutrition.
Lymphangiectasia results in a condition called protein-losing enteropathy, which is the abnormal loss of protein from the digestive tract or the inability of the digestive tract to absorb proteins. This disorder is often lumped in with other malabsorption diseases or protein-losing enteropathies, but it actually has its own distinct characteristics and causes.
Is My Pet at Risk for Lymphangiectasia?
Lymphangiectasia is rarely seen in cats. It's more common in dogs, especially the Yorkie. In addition, the soft-coated Wheaten Terrier and the Basenji also seem predisposed to the disorder.
The average age of dogs with this condition is five, but it is also seen in older and younger dogs. Females are slightly more likely to acquire the disease than males.
Lymphangiectasia can be either a primary disease or secondary to another disorder. When the disease is primary it is congenital, which means inherited. It takes the form of intestinal lymphangiectasia, widespread lymphatic abnormalities, chylothorax (accumulation of lymphatic fluid in the chest cavity), cholecystitis (accumulation of lymphatic fluid in the abdominal cavity), a thoracic duct obstruction, or lymphedema, which is swelling of the body due to poor lymphatic drainage.
Secondary causes of lymphangiectasia are much more common and include cancer, hepatic veno-occlusive disease, constrictive pericarditis, and right-sided heart failure.
Inflammatory bowel disease, also called IBD, is often diagnosed along with lymphangiectasia. But it's not clear whether one of these conditions precedes the other, or whether they are both a result of the same disease process. My strong belief is that chronic gut inflammation is the root cause of IBD, which precedes lymphangiectasia.
Symptoms and Diagnosis
Symptoms of lymphangiectasia include vomiting, chronic diarrhea, loss of appetite, weight loss, lethargy, fluid accumulation in the abdomen and sometimes under the skin, excessive gas, and difficulty breathing due to fluid buildup in the chest.
The major clinical symptom of lymphangiectasia is protein loss, but there are several other disorders that also involve loss of protein, and those must be ruled out before a confirmed diagnosis can be made.
Your vet will run a complete blood profile. In particular, he or she will be looking for a low lymphocyte count, which is almost always present in cases of lymphangiectasia. A low cholesterol level due to loss of lymph fluid and a low albumin level, which is a type of protein, will also be present and are very consistent with this particular disease.
A urinalysis will also be done as well as a fecal smear and flotation to check for intestinal parasites. Feces may also be cultured to look for infectious agents.
Chest and abdominal X-rays and sometimes an abdominal ultrasound may be taken to rule out various forms of heart disease and cancer. If a problem with the heart is suspected, an ECG may be necessary.
Your vet will probably also perform an endoscopy, which is passing a camera down into the GI tract to examine and collect microscopic tissue samples for analysis.
Treatment of Lymphangiectasia
The first step in treating most cases of lymphangiectasia is to address the inflammation that is always present. Traditional veterinarians like to use drugs like Prednisone and Azathioprine. Integrative vets prefer natural GI anti-inflammatories to decrease or offset the pharmaceutical drugs required to treat the condition.
The pet's diet must also be addressed. I recommend patients consume medium-chain triglycerides (MCTs), as these helpful fats are diffused across the GI wall with no digestion required. The natural form of MCTs I prefer for my patients is organic raw coconut oil. I also recommend a low-residue, low-fat, bland, novel protein diet during treatment, and also a product called Seacure, which can help the GI tract heal.
Natural and traditional diuretics are also commonly used to help increase the amount of urination and reduce the amount of fluid accumulation throughout the body. Percussing or tapping the parts of an animal's body where fluid has accumulated can also be beneficial. Occasional suctioning of the fluid may also be required.
Mild exercise, therapeutic massage, and veterinary laser therapy can be very beneficial to help move lymph. If the condition is secondary to another disease that can be resolved or well-controlled, there's a good chance the lymphangiectasia can be managed into long-term periods of remission.
I have found the majority of cases of this disease in my practice are the result of significant GI inflammation and degeneration. When the gut is finally healed, the secondary lymph issues also resolve.