DOCSLIB.ORG

The Clinical Efficacy of Dietary Fat Restriction in Treatment of Dogs

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
The Clinical Efficacy of Dietary Fat Restriction in Treatment of Dogs J Vet Intern Med 2014;28:809–817 The Clinical Efficacy of Dietary Fat Restriction in Treatment of Dogs with Intestinal Lymphangiectasia H. Okanishi, R. Yoshioka, Y. Kagawa, and T. Watari Background: Intestinal lymphangiectasia (IL), a type of protein-losing enteropathy (PLE), is a dilatation of lymphatic vessels within the gastrointestinal tract. Dietary fat restriction previously has been proposed as an effective treatment for dogs with PLE, but limited objective clinical data are available on the efficacy of this treatment. Hypothesis/Objectives: To investigate the clinical efficacy of dietary fat restriction in dogs with IL that were unrespon- sive to prednisolone treatment or showed relapse of clinical signs and hypoalbuminemia when the prednisolone dosage was decreased. Animals: Twenty-four dogs with IL. Methods: Retrospective study. Body weight, clinical activity score, and hematologic and biochemical variables were compared before and 1 and 2 months after treatment. Furthermore, the data were compared between the group fed only an ultra low-fat (ULF) diet and the group fed ULF and a low-fat (LF) diet. Results: Nineteen of 24 (79%) dogs responded satisfactorily to dietary fat restriction, and the prednisolone dosage could be decreased. Clinical activity score was significantly decreased after dietary treatment compared with before treat- ment. In addition, albumin (ALB), total protein (TP), and blood urea nitrogen (BUN) concentration were significantly increased after dietary fat restriction. At 2 months posttreatment, the ALB concentrations in the ULF group were signifi- cantly higher than that of the ULF + LF group. Conclusions and Clinical Importance: Dietary fat restriction appears to be an effective treatment in dogs with IL that are unresponsive to prednisolone treatment or that have recurrent clinical signs and hypoalbuminemia when the dosage of prednisolone is decreased. Key words: Canine; Inflammatory bowel disease; Protein-losing enteropathy. rotein-losing enteropathy (PLE) refers to intestinal Pdisorders characterized by gastrointestinal protein Abbreviations: loss of such magnitude as to result in hypoalbumin- ACVP American College of Veterinary Pathologists 1,2 emia. Intestinal lymphangiectasia (IL), a type of ALB albumin PLE, involves dilatation of lymphatic vessels within BUN blood urea nitrogen the gastrointestinal tract.3 IL may be a primary dis- Ca calcium ease, but typically is a secondary process in dogs.4,5 CBC complete blood count The most common mechanisms associated with sec- CCECAI canine chronic enteropathy clinical activity index ondary IL in dogs include increased lymphatic pressure CRP c-reactive protein caused by inflammatory bowel disease (IBD), lym- DER daily energy requirement phoma, or infectious diseases, and increased venous IBD inflammatory bowel disease pressure at the level of the thoracic duct attributable IL intestinal lymphangiectasia to right-sided heart failure, pericarditis, or pericardial LF low-fat effusion.6 Clinical signs include vomiting, diarrhea, LPE lymphocytic-plasmacytic enteritis weight loss, and ascites, but these signs may not PCV packed cell volume PLE protein-losing enteropathy T. Chol total cholesterol TP total protein From the Laboratory of Comprehensive Veterinary Clinical ULF ultra low-fat Studies, Department of Veterinary Medicine, College of WBC white blood cell Bioresource Sciences, Nihon University, Kanagawa, Japan WSAVA World Small Animal Veterinary Association (Okanishi, Yoshioka, Watari); and the NORTH LAB Inc, Hokkaido, Japan (Kagawa). Corresponding author: Toshihiro Watari, Laboratory of Com- prehensive Veterinary Clinical Studies, Department of Veterinary always be present. Laboratory abnormalities associated Medicine, Faculty of Bioresource Sciences, Nihon University, 1866 with IL include hypoalbuminemia, panhypoprotein- Kameino, Fujisawa, Kanagawa 252-0880, Japan; e-mail: emia, lymphopenia, hypocalcemia, and hypocholester- [email protected]. olemia.7 Definitive diagnosis of IL is obtained by Submitted September 24, 2013; Revised December 16, 2013; histopathologic evaluation of intestinal biopsy specimens, Accepted January 14, 2014. which can be obtained surgically or endoscopically.6,7 © 2014 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of American College There are several treatment modalities for PLE, of Veterinary Internal Medicine. including immunosuppressive agents (eg, prednisolone, This is an open access article under the terms of the Creative cyclosporine), dietary treatment (low-fat or hypoaller- Commons Attribution-NonCommercial-NoDerivs License, which genic diet), hydroxeythyl starches, and nutritional sup- permits use and distribution in any medium, provided the original plementations (vitamins or minerals). Prednisolone work is properly cited, the use is non-commercial and no treatment is commonly used for IL (particularly with modifications or adaptations are made. 7,8 DOI: 10.1111/jvim.12327 IBD) and is effective in many cases. However, some 810 Okanishi et al dogs with IL caused by IBD have an unsatisfactory ALB concentration or clinical signs after these treatments and response to prednisolone treatment or recurrence of intestinal biopsy was performed. Prednisolone treatment was clinical signs or hypoalubuminemia when the predniso- instituted after IL had been definitively diagnosed. The initial – lone dosage is decreased.8,9 Steroid treatment may be prednisolone dosage was 1 2 mg/kg/day PO (1 mg/kg/day, = = ineffective because of severe mucosal inflammation or n 13; 2 mg/kg/day, n 11), according to commonly used dos- ages,7,8 and the dosage was decreased every 2–4 weeks if a satis- malabsorption, and clinical signs may recur when the factory response, based on improvement of clinical signs and prednisolone dosage is decreased because of exacerba- ALB concentration, was achieved. tion of mucosal inflammation. The criteria for commencement of dietary fat restriction were An ultra low-fat (ULF) diet composed of turkey as follows: (1) improvement of ALB concentration and clinical breast and potato previously was proposed as part of signs with prednisolone treatment but decrease in ALB concen- the treatment for PLE in dogs by Peterson and tration and exacerbation of clinical signs with reduction in pred- Willard.10 ULF diets are thought to decrease the leak- nisolone dosage or (2) no improvement of ALB concentration age of protein and lipid into the intestinal lumen more and clinical signs after prednisolone treatment for >4 weeks. The than low-fat (LF) diets because of decreased lymphatic medical records of dogs that received dietary fat restriction were pressure. However, objective information on the effi- retrospectively reviewed. The ULF diet was based on the report by Peterson and Wil- cacy of dietary fat restriction including ULF dietary lard and was composed of 1 part chicken breast without skin treatment in PLE dogs has not been reported, and lim- plus 2 parts white potato without skin (all boiled, baked, or ited clinical data on the efficacy of dietary fat restric- microwaved) or rice.10 We replaced the turkey breast in the ULF tion in canine PLE are available. diet of Peterson and Willard with chicken breast in this present Therefore, the purpose of this present study was to study. Chicken breast is composed mainly of protein with hardly evaluate the clinical efficacy of dietary fat restriction in any fat, and provides 125 kcal per 100 g meat (including protein, dogs with IL that were unresponsive to prednisolone 27.3 g; fat, 1.0 g; carbohydrate, 0 g; ash, 1.1 g; water, 70.6 g; treatment or experienced a recurrence of clinical signs sodium, 29 mg; potassium, 350 mg; calcium, 4 mg; magnesium, or hypoalbuminemia when the prednisolone dosage 32 mg; phosphorus, 220 mg; iron, 0.3 mg; zinc, 0.7 mg; copper, was decreased. Furthermore, we investigated the possi- 0.03 mg; manganese, 0.01 mg; vitamin B1, 0.09 mg; and vitamin B2, 0.12 mg). White potato is composed mainly of carbohydrates bility of a reduction in prednisolone dosage with die- with little protein, and provides 84 kcal per 100 g potato (includ- tary fat restriction. ing protein, 1.5 g; fat, 0.1 g; carbohydrate, 19.7 g; ash, 0.6 g; water, 78.1 g; sodium, 1.0 mg; potassium, 330 mg; calcium, Materials and Methods 2 mg; magnesium, 20 mg; phosphorus, 23 mg; iron, 0.3 mg; zinc, 0.2 mg; copper, 0.08 mg; manganese, 0.13 mg; vitamin C, 15 mg; 11 Dogs and vitamin B6, 0.16 mg). Among the 24 dogs that received dietary fat restriction, dogs fed only the ULF diet were catego- + Medical records of 27 dogs with IL fed ULF or ULF LF rized as the ULF group, and dogs fed 1 part ULF diet plus 1 diet, among dogs admitted to the Animal Medical Center of part LF dry canine food (Veterinary Diet Gastrointestinal Low Nihon University from November 2010 to March 2013 with signs Fat, Royal Caninb or Prescription Diet w/d Caninec) were cate- of chronic gastrointestinal disease (ie, vomiting, diarrhea, weight gorized as the ULF + LF group. The ULF and LF combination loss) of more than 3 weeks’ duration, were reviewed for inclusion diet was used because the ULF diet alone may lead to nutritional in the study. The dogs underwent a thorough investigation, imbalances of minerals and vitamins. Therefore, LF dry canine including complete blood count, serum biochemistry profile, par- food (complete and balanced dry canine food) was mixed with asitologic and bacteriologic examination of feces (for nematodes, the ULF diet in equal parts. We considered that the blend would Giardia spp., Trichomonas spp., and Campylobacter spp.), urinal- be more nutritious than the ULF diet alone, and have a lower ysis, radiographic examination, ultrasound examination, and fat content than the LF diet alone. However, certain dogs were endoscopy with intestinal biopsy sampling to exclude other fed only the ULF diet because we considered that the ULF diet causes of gastrointestinal signs. Inclusion criteria included hypo- alone might decrease the leakage of protein and lipid into the < albuminemia (ALB 2.7 g/dL) and histopathologic confirmation intestinal lumen more effectively than the ULF + LF diet because of IL.
Load more

Recommended publications
  • An Atypical Case of Recurrent Cellulitis/Lymphangitis in a Dutch Warmblood Horse Treated by Surgical Intervention A
    EQUINE VETERINARY EDUCATION / AE / JANUARY 2013 23 Case Report An atypical case of recurrent cellulitis/lymphangitis in a Dutch Warmblood horse treated by surgical intervention A. M. Oomen*, M. Moleman, A. J. M. van den Belt† and H. Brommer Department of Equine Sciences and †Companion Animals, Division of Diagnostic Imaging, Faculty of Veterinary Medicine, Utrecht University, Yalelaan, Utrecht, The Netherlands. *Corresponding author email: [email protected] Keywords: horse; lymphangitis; lymphoedema; surgery; lymphangiectasia Summary proposed as a possible contributing factor for chronic The case reported here describes an atypical presentation progressive lymphoedema of the limb in these breeds of of cellulitis/lymphangitis in an 8-year-old Dutch Warmblood horses (de Cock et al. 2003, 2006; Ferraro 2003; van mare. The horse was presented with a history of recurrent Brantegem et al. 2007). episodes of cellulitis/lymphangitis and the presence of Other diseases related to the lymphatic system are fluctuating cyst-like lesions on the left hindlimb. These lesions lymphangioma/lymphangiosarcoma and development appeared to be interconnected lymphangiectasias. Surgical of lymphangiectasia. Cutaneous lymphangioma has been debridement followed by primary wound closure and local described as a solitary mass on the limb, thigh or inguinal drainage was performed under general anaesthesia. Twelve region of horses without the typical signs of progressive months post surgery, no recurrence of cellulitis/lymphangitis lymphoedema (Turk et al. 1979; Gehlen and Wohlsein had occurred and the mare had returned to her former use as 2000; Junginger et al. 2010). Lymphangiectasias in horses a dressage horse. have been described in the intestinal wall of foals and horses with clinical signs of colic and diarrhoea (Milne et al.
    [Show full text]
  • Lympho Scintigraphy and Lymphangiography of Lymphangiectasia
    supplement to qualitative interpretation of scintiscans, pulmo 13. Hirose Y, lmaeda T, Doi H, Kokubo M, Sakai 5, Hirose H. Lung perfusion SPECT in nary perfusion scintigraphy will become a more useful tech predicting postoperative pulmonary function in lung cancer. Ann Nuc/ Med 1993:7: 123—126. nique for clinical evaluation of treatment and assessment of 14. Hosokawa N, Tanabe M, Satoh K. et al. Prediction of postoperative pulmonary breathlessness and respiratory failure than the usual one. function using 99mTcMAA perfusion lung SPECT. Nippon Ada Radio/ 1995;55:414— 422. 15. Richards-Catty C, Mishkin FS. Hepatic activity on perfusion lung images. Semi,, Nuci REFERENCES Med l987;l7:85—86. I. Wagner UN Jr. Sabiston DC ir, McAee JG, Tow D, Stem HS. Diagnosis of massive 16. Kitani K, Taplin GV. Biliary excretion of9@―Tc-albuminmicroaggregate degradation pulmonaryembolism in man by radioisotopescanning.N Engli Med 1964;27l:377-384. products (a method for measuring Kupifer cell digestive function?). J Naic! Med 2. Maynard CD. Cowan Ri. Role of the scan in bronchogenic carcinoma. Semin Nuci 1972:13:260—265. Med 1971;l:195—205. 17. Marcus CS, Parker LS, Rose 1G. Cullison RC. Grady P1. Uptake of ‘@“Tc-MAAby 3. Newman GE, Sullivan DC, Gottschalk A, Putman CE. Scintigraphic perfusion pattems the liver during a thromboscintigram/lung scan. J Nuci Med 1983;24:36—38. in patients with diffuse lung disease. Radiology 1982;l43:227—23l. 18. Gates GF, Goris ML. Suitability of radiopharmaceuticals for determining right-to-left 4. Clarke SEM, Seeker-Walker RH. Lung scanning.
    [Show full text]
  • Inflammatory Bowel Disease (IBD)
    Inflammatory Bowel Disease (IBD) What are the stomach and intestines and what do they do? The stomach and intestines are part of the gastrointestinal system. The bowel is the large and small intestines. Food is swallowed and travels down the esophagus to the stomach. Here, food is broken down and mixed before traveling into the intestines. The small intestine further digests particles of food and then absorbs nutrients. The large intestine absorbs water and forms and stores the feces. There are normally large numbers of bacteria in the intestines that aid in digestion and processing of nutrients. The duodenum, jejunum, and ileum make up the small intestine The colon is the large intestine The cecum is a small pouch at the junction of the small and large intestines that serves little purpose in dogs and cats, similar to the appendix in people Proteins, carbohydrates, fats, water and electrolytes are just some of the compounds that are absorbed via the intestines What is inflammatory bowel disease (IBD)? IBD is characterized by inflammation in the bowel. The small intestine is the most commonly affected site, but the colon and stomach can also be affected. When inflammatory cells migrate into the bowel a number of clinical signs and laboratory changes can result. The type of inflammation in the bowel may vary depending on the severity and cause of the IBD. With chronicity, fibrosis (scarring) of the bowel can be observed. Inflammation is an increase in white blood cells in a tissue; examples of white cells include lymphocytes, plasma
    [Show full text]
  • Lymphangiectasia)
    DILATION OF LYMPHATIC VESSELS IN THE GASTROINTESTINAL TRACT (LYMPHANGIECTASIA) BASICS OVERVIEW “Lymphatic vessels” are vascular channels (similar to veins) that transport lymph; “lymph” is a clear to slightly colored fluid that contains white-blood cells—it circulates through the lymphatic vessels removing bacteria and other materials from body tissues and it also transports fat from the small intestines; it eventually empties into the blood, returning tissue fluids into the general body circulation “Lymphangiectasia” is defined as the dilation of the lymphatic vessels in the gastrointestinal tract; the “gastrointestinal tract” includes the stomach, small intestines, and large intestines Lymphangiectasia is an obstructive disorder of the lymphatic system of the gastrointestinal tract, resulting in the loss of body proteins through the intestines (known as “protein-losing enteropathy”) GENETICS A familial tendency for the condition in which proteins are lost from the body through the intestines (protein-losing enteropathy) has been reported for soft-coated wheaten terriers, basenjis, and Norwegian lundehunds; “familial” indicates a condition that runs in certain families or lines of dogs SIGNALMENT/DESCRIPTION of ANIMAL Species Dogs Breed Predilections Increased likelihood of lymphangiectasia seen in soft-coated wheaten terriers, basenjis, Norwegian lundehunds, and Yorkshire terriers as compared to other dog breeds Age Dogs of any age can be affected Most common in middle-aged dogs Predominant Sex Increased likelihood of lymphangiectasia
    [Show full text]
  • Statistical Analysis Plan
    Cover Page for Statistical Analysis Plan Sponsor name: Novo Nordisk A/S NCT number NCT03061214 Sponsor trial ID: NN9535-4114 Official title of study: SUSTAINTM CHINA - Efficacy and safety of semaglutide once-weekly versus sitagliptin once-daily as add-on to metformin in subjects with type 2 diabetes Document date: 22 August 2019 Semaglutide s.c (Ozempic®) Date: 22 August 2019 Novo Nordisk Trial ID: NN9535-4114 Version: 1.0 CONFIDENTIAL Clinical Trial Report Status: Final Appendix 16.1.9 16.1.9 Documentation of statistical methods List of contents Statistical analysis plan...................................................................................................................... /LQN Statistical documentation................................................................................................................... /LQN Redacted VWDWLVWLFDODQDO\VLVSODQ Includes redaction of personal identifiable information only. Statistical Analysis Plan Date: 28 May 2019 Novo Nordisk Trial ID: NN9535-4114 Version: 1.0 CONFIDENTIAL UTN:U1111-1149-0432 Status: Final EudraCT No.:NA Page: 1 of 30 Statistical Analysis Plan Trial ID: NN9535-4114 Efficacy and safety of semaglutide once-weekly versus sitagliptin once-daily as add-on to metformin in subjects with type 2 diabetes Author Biostatistics Semaglutide s.c. This confidential document is the property of Novo Nordisk. No unpublished information contained herein may be disclosed without prior written approval from Novo Nordisk. Access to this document must be restricted to relevant parties.This
    [Show full text]
  • Genetic Causes of Lymphedema 3 Matthieu J
    Genetic Causes of Lymphedema 3 Matthieu J. Schlögel , Pascal Brouillard , Laurence M. Boon , and Miikka Vikkula Key Points • Panel-based targeted next-generation sequenc- • Careful patient examination for all signs and ing is the most effi cient approach for diagnos- symptoms is important for precise clinical tic screens. diagnosis. • Secondary lymphedema may be infl uenced by • Primary lymphedema has a high underlying genetic predisposition. genetic heterogeneity. Currently, 20 genes are implicated. • Neonatal edema, including non-immune Introduction hydrops fetalis, can also be caused by muta- tions in some of these genes. Lymphedema is known since the middle of the • Genetic predisposing factors are unknown for nineteenth century, yet the fi rst genes associated a large fraction of patients. with this condition have been discovered only in • There is large variability in clinical expressiv- the twenty-fi rst century. Since then, more than ity and often incomplete penetrance for all 20 genes have been linked to the development of signs and symptoms. primary lymphedema. Originally discovered using linkage analysis in large families or animal models, the more recent approach using Next- Generation Sequencing (NGS) has allowed to discover genes using smaller families and even sporadic cases. In parallel, detailed in vitro and M. J. Schlögel , M.Sc. • P. Brouillard , Ph.D. in vivo studies on molecular and cellular mecha- Laboratory of Human Molecular Genetics, de Duve Institute , Université catholique nisms involved in lymphangiogenesis have unrav- de Louvain , Brussels , Belgium eled numerous novel functional candidate genes. L. M. Boon , M.D., Ph.D. Primary lymphedema can be present as an Cliniques universitaires Saint-Luc, Center inherited or a sporadic trait.
    [Show full text]
  • The Oral Manifestations of Intestinal Lymphangiectasia
    Theoral manifestationsof intestinal lymphangiectasia:case report Patrick M. Ralph, DMDKenneth C. Troutman, DDS, MPH Abstract patients with primary IL in whomstandard in vitro 6 Intestinal lymphangiectasiais a rare autosomaldomi- tests of neutrophil function were abnormal. In addi- nant disorder or acquired condition that leads to lymph tion, patients with IL have been shown to have im- paired cellular immunity secondary to loss of lympho- obstruction, poor chyle transport, and concomitantprob- 14,1s lems of hypoproteinemia, lymphocytopenia, hypogam- cytes into the bowel lumen. Consequently, these maglobulinemia,and peripheral edema. Patients develop patients potentially have impaired neutrophil (PMN) diarrhea, steatorrhea, and hypocalcemiasecondary to fat- function. Patients with IL also have compromisedcal- soluble vitamin malabsorption.Treatment is a restrictive cium and vitamin D homeostasis leading to defects of diet of low fat, mediumchain triglycerides. Oral manifes- both hard and soft tissues in the oral cavity. tations are gingivitis due to poor PMNfunction and The most apparent oral complications associated enameldefects due to poor calciumabsorption. A case of a with patients diagnosed with IL are hypoplastic enamel 14-year-old boy with both gingival and enamel problems defects (HED)and to a lesser extent, but not insignifi- secondary to intestinal lymphangiectasia is reported. cant, gingivitis. Both can lead to prematuretooth loss. (Pediatr Dent 18:461-64, 1996) IL patients present a chronic disruptive disorder of enamel enabling one to determine the severity and duration of the morphogenic disturbance from the ntestinal lymphangiectasia(IL) is a rare disorder 16 the small intestine characterized by dilated lymph- HED. IL patients have poor calcium and vitamin D I atics.
    [Show full text]
  • Intestinal Lymphagiectasia with Normal Immunological Function: a Case Report T
    Henry Ford Hospital Medical Journal Volume 18 | Number 1 Article 10 3-1970 Intestinal Lymphagiectasia with Normal Immunological Function: A Case Report T. Madhavan C. E. Rupe Follow this and additional works at: https://scholarlycommons.henryford.com/hfhmedjournal Part of the Life Sciences Commons, Medical Specialties Commons, and the Public Health Commons Recommended Citation Madhavan, T. and Rupe, C. E. (1970) "Intestinal Lymphagiectasia with Normal Immunological Function: A Case Report," Henry Ford Hospital Medical Journal : Vol. 18 : No. 1 , 65-72. Available at: https://scholarlycommons.henryford.com/hfhmedjournal/vol18/iss1/10 This Article is brought to you for free and open access by Henry Ford Health System Scholarly Commons. It has been accepted for inclusion in Henry Ford Hospital Medical Journal by an authorized editor of Henry Ford Health System Scholarly Commons. Henry Ford Hosp. Med. Journal Vol. 18, No. 1, 1970 Intestinal Lymphagiectasia with Normal Immunological Function A Case Report T. Madhavan, M.D.* and C. E. Rupe, M.D.** A patient is reported with histologically proven intestinal lymphangiectasia and protein losing enteropathy. The gastrointestinal protein loss and the effect of low fat diet have been demonstrated. The morphological abnormalities with radio­ logical and lymphangiographic findings are discussed. Immunological studies are analyzed. These patients may have normal function both humoral and cellular, in spite of fairly advanced disease. Also the new hereto unreported association of Graves' Disease arid intestinal lymphangiectasia has been brought out. The syndrome of lymphangiectasia ization at that time (June, 1966), all the with hypercatabolic protein loss was pertinent laboratory findings were normal except for a total protein of 6.2 gm/100 cc; first described in 1961 by Waldmann an albumin of 3.68 gm/100 cc; aiglobulin et al, who reported a group of 12 pa­ 0.39 gm/lOOcc; a^globuUn 0.67 gm/100 tients with hypoproteinemia and exuda­ cc, and gamma globulin 0.84 gm/100 cc.
    [Show full text]
  • Neonatal-Perinatal Medicine Content Outline
    THE AMERICAN BOARD OF PEDIATRICS® CONTENT OUTLINE Neonatal-Perinatal Medicine Subspecialty In-Training, Certification, and Maintenance of Certification (MOC) Examinations INTRODUCTION This document was prepared by the American Board of Pediatrics Subboard of Neonatal-Perinatal Medicine for the purpose of developing in-training, certification, and maintenance of certification examinations. The outline defines the body of knowledge from which the Subboard samples to prepare its examinations. The content specification statements located under each category of the outline are used by item writers to develop questions for the examinations; they broadly address the specific elements of knowledge within each section of the outline. Neonatal-Perinatal Medicine Each Neonatal-Perinatal Medicine exam is built to the same specifications, also known as the blueprint. This blueprint is used to ensure that, for the initial certification and in-training exams, each exam measures the same depth and breadth of content knowledge. Similarly, the blueprint ensures that the same is true for each Maintenance of Certification exam form. The table below shows the percentage of questions from each of the content domains that will appear on an exam. Please note that the percentages are approximate; actual content may vary. Initial Maintenance Certification of Content Categories and Certification In-Training (MOC) 1. Maternal-Fetal Medicine 6% 6% 2. Asphyxia and Resuscitation 4% 6% 3. Cardiovascular 9% 8% 4. Respiratory 12% 12% 5. Genetics/Dysmorphism 7% 6% 6. Nutrition 8% 8% 7. Water/Salt/Renal 5% 5% 8. Endocrine/Metabolic/Thermal 5% 5% 9. Immunology 3% 2% 10. Infectious Diseases 6% 7% 11. Gastroenterology 4% 4% 12. Bilirubin 2% 4% 13.
    [Show full text]
  • Protein-Losing Enteropathy in Primary Lymphangiectasia
    Crutzen B, Poncelet P-A. Protein-Losing Enteropathy in Primary Lymphangiectasia. Journal of the Belgian Society of Radiology. 2020; 104(1): 34, 1–2. DOI: https://doi.org/10.5334/jbsr.2136 IMAGES IN CLINICAL RADIOLOGY Protein-Losing Enteropathy in Primary Lymphangiectasia Bernard Crutzen and Pierre-Antoine Poncelet Teaching Point: Intestinal lymphangectasia should be evoked in the rare context of protein-losing enter- opathy with low-attenuation thickening of the bowel wall. Keywords: Lymphangectasia; waldmann; lymphangioma; enteropathy; hyponatremia; protein Case Report (Figure 2A, arrows), and a 10-centimeter mesenteric A 54-year-old female was hospitalized for severe hypona- cystic mass extending to the liver hilum without tissue tremia and electrolytic troubles. She had increasing infiltration (Figure 2B, arrow). fatigue, loss of appetite and lower limbs edema. Abdomi- The radiological features and its localization highly nal contrast-enhanced computed tomography (CT) suggested the diagnosis of cystic lymphangioma. Final revealed circumferential parietal thickening of the proxi- diagnosis was primary intestinal lymphangiectasia, also mal duodenum, with low attenuation of the submucosal known as Waldmann’s disease. layer (Figure 1A and B, arrows). There was no fat infiltration nor vessel hypertrophy sug- Discussion gestive of inflammatory bowel disease. Endoscopic explo- Waldmann’s disease or primary intestinal lymphangiec- ration showed mucosal ulcerative lesion and the biopsy tasia is usually diagnosed in children, but few cases have revealed focal lymphangiectasias in the submucosal layer. been reported in adults. It is characterized by lymphatic Clinical presentation associated with biological and histo- dilatation and results in excessive loss of proteins into logical findings suggested the diagnosis of protein-losing the intestinal lumen leading to lower limbs edemas, enteropathy (PLE).
    [Show full text]
  • Successful Treatment of Protein-Losing Enteropathy Induced by Intestinal Lymphangiectasia in a Liver Cirrhosis Patient with Octreotide : a Case Report
    J Korean Med Sci 2004; 19: 466-9 Copyright � The Korean Academy ISSN 1011-8934 of Medical Sciences Successful Treatment of Protein-Losing Enteropathy Induced by Intestinal Lymphangiectasia in a Liver Cirrhosis Patient with Octreotide : A Case Report A 47-yr-old man with hepatitis B virus associated liver cirrhosis was admitted to our Hang Lak Lee, Dong Soo Han, hospital with diarrhea and generalized edema and diagnosed as protein-losing en- Jin Bae Kim, Yong Chul Jeon, teropathy due to intestinal lymphangiectasia by intestinal biopsy and 99mTc albumin Joo Hyun Sohn, Joon Soo Hahm scan. During hospitalization, he received subcutaneous octreotide therapy. After 2 Department of Internal Medicine, Hanyang University weeks of octreotide therapy, follow-up albumin scan showed no albumin leakage, Kuri Hospital, Guri, Korea and the serum albumin level was sustained. We speculate that liver cirrhosis can be a cause of intestinal lymphangiectasia and administration of octreotide should Received : 4 June 2003 be considered for patients with intestinal lymphangiectasia whose clinical and bio- Accepted : 4 August 2003 chemical abnormalities do not respond to a low-fat diet. Address for correspondence Dong Soo Han, M.D. Department of Gastroenterology, Hanyang University Kuri Hospital, 249-1 Gyomun-dong, Guri 471-701, Korea Tel : +82.31-560-2226, Fax : +82.31-555-2998 Key Words : Lymphagiectasis, Intestinal; Protein-Losing Enteropathies; Octreotide E-mail: [email protected] INTRODUCTION been diagnosed as liver cirrhosis, but he received no specific treatment. On admission, he complained of diffuse abdominal Intestinal lymphangiectasia is a relatively rare disorder char- cramping pain and watery diarrhea. His blood pressure was acterized by dilated intestinal submucosal lymphatics with a 100/50 mmHg; heart rate 72 beats/min; respiratory rate 24 loss of lymph into the bowel lumen (1).
    [Show full text]
  • Canine Protein Losing Enteropathies Willard, M
    Canine Protein Losing Enteropathies Willard, M. Texas A&M University, Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Texas, USA. * Corresponding Author: Dr. Michael Willard, DVM, DACVIM. College of Veterinary Medicine, Department of Small Animal Clinical Sciences, TAMU- 4474, Texas A&M University, College Station, TX 77843-4474, USA. Email: [email protected] ABSTRACT Protein-losing enteropathies are traditionally thought of as being diseases with a very poor prognosis. While this is often true, there are subsets of these patients which, if diagnosed in a timely fashion, may often have a relatively good prognosis. Lymphangiectasia in particular is a disease that is often misdiagnosed or diagnosed so late that it is no longer treatable. Clinicians should actively seek for evidence of lymphangiectasia in dogs with protein-losing enteropathies as this can be a disease that they may be able to control for years, at least in some cases. Keywords: Canine; Lymphangiectasia; Hypoalbuminemia; Diagnosis REVIEW may lose over half of their plasma proteins and consequently While relatively uncommon in human medicine, protein- have normal serum globulin concentrations. Conversely, losing enteropathies (PLE) are actually relatively common in occasional panhypoproteinemic dogs have hepatic disease dogs (1). Historically, they have tended to be associated with or glomerular disease as the major source of protein loss, severe diseases, and were considered to have a poor prognosis. for reasons which are not clear. Therefore, the work up for (2) However, new data suggests that there is a subset of these hypoalbuminemic dogs is the same regardless of whether or animals that can actually respond reasonably well to therapy not they are panhypoproteinemic.
    [Show full text]