Case 6

In Roxy's case, along with the low albumin concentration, her globulin concentration is at the low end of normal. This makes liver disease less likely, and you have ruled out glomerular disease, so a protein losing enteropathy (PLE) goes to the top of the differential list. It is important to note, however, that not all cases follow these trends and that even patients with normal liver panel results may have abnormal liver function.

Causes of PLE

• Neoplasia (e.g. lymphoma)

• Infectious

-Fungal (histoplasmosis, pythiosis)

-Viral (parvovirus)

• Inflammatory bowel disease (IBD)

• Lymphangiectasia

-Primary (breed-related)

-Secondary (e.g. right heart failure, portal hypertension)

• GI hemorrhage (e.g. hookworms, bleeding ulcers)

QUESTION 3

What is your next diagnostic recommendation for Roxy? (

There is more than one correct response

.)

a) An abdominal ultrasonographic examination

b) Abdominal exploratory and biopsy

c) Endoscopic evaluation of the stomach and small intestine with biopsy

d) Treat for GI disease with diet and corticosteroids

e) Bile acids testing

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