Intestinal Lymphangiectasia in Dogs

In regular body function, the intestinal system works to remove the nutrients from food and drink to be utilized throughout the body. Disruptions to this process can lead to widespread, systemic concerns as each nutrient can be needed for a number of processes in multiple parts of the body.

Lymphangiectasia is an uncommon condition that is challenging to manage. Early detection is important for good outcomes, therefore prompt veterinary attention is required.

Lymphangiectasia occurs in all breeds, but is more common in certain breeds including:

• Soft coated wheaten terriers
• Yorkshire terriers
• Norwegian lundehunds
• Basenjis

The severity of lymphangiectasia depends on the underlying cause, how much of the intestine is affected, and how the nutrient loss is affecting the other systems in the body.

In cases where the only part of the intestines are affected, other parts of the intestinal tract absorb the lost nutrients as they are passed along. In this case, the amount of protein and fat lost into the intestine is minimal, and symptoms are mild

In cases where the entire system is affected, the dog is losing large amounts of fat and protein into the intestinal tract, and there is minimal capacity for reabsorption to occur. In these cases, the symptoms are severe and can be life-threatening.

In some cases, fluid gathers in the chest and compresses the lungs. This causes difficulty breathing and puts stress on the heart.

In some cases, anticoagulant proteins are lost into the intestine. Without these proteins, the blood is prone to clotting. If a clot lodges itself in a vein or artery, it causes an embolism which can be fatal.

In some cases, lymphangiectasia occurs at the same time as other intestinal diseases such as gastric cancers, or irritable bowel disease. The presence of more than one issue complicates recovery.

Lymphangiectasia occurs when the flow of lymph in the intestines is altered. The lymphatics in the intestine are primarily involved in absorbing fat from the diet. Altered lymphatic flow can be due to obstruction in the system itself, increased pressure within the lymphatic vessels, or due to inflammation in the intestinal system. Eventually, the delicate lymphatic vessels become so filled with fluid that they rupture, causing loss of fat and protein from the body into the intestinal tract.

Without the proper amounts of protein, fat, and other nutrients in the bloodstream, the body tries to compensate. It starts to pull protein from the muscles, resulting in muscle loss.

Proteins that regulate fluid exchange between the bloodstream and the tissues are also lost. Without these proteins, fluid moves into the cavities of the body, causing swelling in the abdomen, compression of the lungs, and swelling of the skin. Proteins that prevent blood clotting are also lost, increasing the risk of developing blood clots within vessels.

Several conditions are associated with this disease, including:

• Heart failure
• Tumors within the intestinal wall
• Malformations of the lymphatic system
• Fungal infections of the intestine

In many cases the cause of lymphangiectasia remains unknown.

The symptoms of lymphangiectasia are vague and non-specific, which means that they point to many different possible underlying causes. Diagnostics aim at confirming lymphangiectasia and ruling out other possible causes of symptoms. Once lymphangiectasia is confirmed, diagnostics are also required to identify the underlying cause, if present. Diagnostic tools include:

• Physical examination
• Bloodwork
• Diagnostic imaging, such as X-rays and ultrasound
• Urinalysis
• Fecal analysis
• Fecal culture
• Analysis of accumulating fluid in the chest or abdomen
• Echocardiogram
• Electrocardiogram
• Liver function test
• Fine needle aspiration
• Biopsy of the intestinal wall

In the case that an underlying cause is determined, treatment aims to resolve it. Most cases of lymphangiectasia resolve if the underlying cause can be managed.

In the case where no underlying cause is determined, treatment aims to manage the nutritional needs of the dog and avoid complications, as there is no cure for lymphangiectasia.

Dogs with lymphangiectasia require nutritional management with a highly digestible, protein-rich, low-fat diet. Prescription diets are available from veterinarians. Cooking homemade food is possible, but requires extreme precision to manage the symptoms of this disease. The input of a veterinary nutritionist is necessary to ensure proper formulation.

Alongside dietary changes, treatments include:

• Vitamin supplements
• Anti-inflammatory medications
• Immunomodulating drugs
• Anticoagulant medications
• Diuretics to reduce fluid accumulation
• Draining of fluid from the abdomen and chest

In cases where an underlying cause is identified and treated, the prognosis for lymphangiectasia is good.

In cases where no underlying cause is determined, especially when large parts of the intestine are affected, or where other serious conditions are present, such as intestinal cancer, the prognosis is guarded. There is no cure for this disease, and the progression is highly variable and not all cases respond to dietary management. Ongoing dietary support is required for the rest of the dog’s life. Most dogs with lymphangiectasia die from blood clotting events.

There are no proven preventative measures for lymphangiectasia.

Lymphangiectasia is uncommon in dogs.

• Prescription diet
• Vitamin supplements
• Anti-inflammatory medications
• Anticoagulant medications
• Draining of the abdomen and chest