Practice Scenario

Say hello to Duffy, a young adult dog with chronic small bowel diarrhea

Meet DUFFY

A 2-year-old, neutered male Bernese Mountain Dog

  • Duffy is presented today for intermittent chronic small bowel diarrhea. Although the owner reports he only defecates 2 to 3 times per day and has no urgency, he does have voluminous soft stools. The owner also reports the diarrhea and flatulence have occurred consistently over the past 6 months. What the owner finds concerning today is Duffy’s lethargy, which started 2 days ago.
  • Duffy currently eats a high-protein dry dog food formulated for all life stages that is purchased at a pet specialty store. The owner reports that the dog’s appetite has been good. Year-round, Duffy is given once-monthly medication to protect against heartworm disease, ticks, fleas, roundworms, and hookworms.
  • Physical exam findings are unremarkable. However, a comparison of Duffy’s weight today with previous body weights in the medical record reveals he has lost weight. His body condition score today is 4/9, compared to 5/9 at previous visits.
  • Blood, urine, and fecal samples are obtained and submitted to a reference laboratory for overnight evaluation. No evidence of intestinal parasites or ova are observed. However, the results of the serum chemistry profile reveal a mild panhypoproteinemia.

Gastrointestinal Disorders

Intestinal Lymphangiectasia in Dogs

Intestinal lymphatic vessel dilatation and lymph leakage into the intestines are characteristics of intestinal lymphangiectasia (IL), one cause of protein-losing enteropathy in dogs. Lymphangiectasia can be an inherited (primary IL) or an acquired (secondary IL) condition, with secondary IL more commonly reported in dogs.

Leakage of protein-, fat- and lymphocyte-rich lymph into the intestinal tract is typically responsible for the clinical signs of weight loss and chronic diarrhea. Vomiting and anorexia also are common signs. Diarrhea may be persistent or intermittentꟷor not present at all. Lymphatic vessel dilation alone or in combination with inflammation results in incomplete breakdown and impaired absorption of nutrients. Malnutrition is considered a common, potentially life-threatening complication.

canine intestines icon

Key Messages

  • Feeding a nutritionally balanced, highly digestible, ultra-low- or low-fat diet that provides sufficient calories and protein is important to the management of dogs with intestinal lymphangiectasia. Restricting dietary fat intake reduces intestinal lymph flow, decreases lacteal distention, and minimizes protein loss.
    • Low-fat diets are lower in calories. In dogs experiencing severe weight loss, selection of a diet containing C8 and C10 medium-chain fatty acids can provide an alternative energy source that is less likely to contribute to lymphatic congestion.
  • The diet should provide enough highly digestible, high-quality protein to replace depleted serum and tissue proteins.
    • A hydrolyzed protein or amino acid-based (i.e., elemental) diet, if low in fat, may be appropriate for patients with concurrent lymphangiectasia and chronic enteropathy.
  • Dogs with lymphangiectasia should be fed small amounts of food 3 to 4 times per day to reduce distention and/or congestion in the GI tract and possibly diarrhea or vomiting.
  • Dogs with lymphangiectasia exhibiting small bowel diarrhea should eat a diet with reduced insoluble fiber since this fiber type reduces digestibility and may increase the risk for impaired protein and carbohydrate absorption.
  • Prebiotic fiber (e.g., soluble or mixed fiber) in the diet may benefit some dogs through increased production of short-chain fatty acids by the microbiota.
conversation starter

“For dogs with lymphangiectasia, an important part of treatment will be food. Specifically, [dog’s name] will need a special diet that is very low in fat and has highly digestible protein and carbohydrates. To help manage your dog’s condition, you will need to feed only the recommended food, including using the food as treats.”

Related Tools and Content:

Protein-Losing Enteropathy in Dogs

Diet plays an important role in the management of dogs with protein-losing enteropathy.

View Brief 1 min to 5 min

Canine Immunosuppressant-Responsive Enteropathy (Inflammatory Bowel Disease)

Diet modification can play an important role in a multimodal approach to managing dogs with immunosuppressant-responsive enteropathy.

View Brief 6 min to 10 min

Purina Fecal Scoring Chart

The Purina Fecal Scoring Chart is a practical, easy-to-use tool that can help clients describe their pets’ stools.

View Tool 1 min to 5 min

How to Perform a Body Condition Assessment - Dog

Assess a dog's Body Condition Score in just 3 simple steps.​

View Video 1 min to 5 min

Use Muscle Condition Scoring to Detect Muscle Loss in Patients

Muscle condition scoring is a hands-on method for evaluating lean body mass that can be used as part of nutritional assessments.

View Brief 1 min to 5 min

To Share With Pet Owner:

Purina Fecal Scoring Chart

The Purina Fecal Scoring Chart is a practical, easy-to-use tool that can help clients describe their pets’ stools.

View Tool 1 min to 5 min

Evaluating Your Dog’s Body Condition

Assess your dog's Body Condition in just 3 simple steps.​

View Video 1 min to 5 min

Additional Resources

Davenport, D. J., Jergens, A. E., & Remillard, R. L. (2010). Protein-losing enteropathies. In M. S. Hand, C. D. Thatcher, R. L. Remillard, P. Roudebush, & B. J. Novotny (Eds.), Small animal clinical nutrition (5th ed., pp. 1077─1083). Mark Morris Institute.

Gaschen, F. P., & Laflamme, D. (2010). Chronic enteropathies–canine. In Nestlé Purina PetCare handbook of canine and feline clinical nutrition (pp. 62─63). Nestlé Purina PetCare Company.

Zoran, D. L. (2010). Lymphangiectasia–canine. In Nestlé Purina PetCare handbook of canine and feline clinical nutrition (pp. 66─67). Nestlé Purina PetCare Company.