Losing \/\/TOP\\\\

Protein-losing enteropathy (PLE) is a syndrome where there is an excess loss of proteins in the gastrointestinal tract. It can occur in many clinical conditions. Management of PLE is complex and challenging and requires a team approach. This activity illustrates the etiology, pathogenesis, signs, and symptoms, work up, and also highlights the role of the interprofessional team in the diagnosis and management of protein-losing enteropathy.

losing

Download File: https://www.google.com/url?q=https%3A%2F%2Furlcod.com%2F2u9crY&sa=D&sntz=1&usg=AOvVaw1v4aj7Tq6iAgthyzCtLsFq

Objectives:Identify the etiology of protein-losing enteropathy.Explain the expected history, physical, and evaluation of protein-losing enteropathy.Outline the treatment and management options available for protein-losing enteropathy.Review the importance of improving care coordination among interprofessional team members to improve outcomes in a patient having protein-losing enteropathy.Access free multiple choice questions on this topic.

Protein-losing enteropathy (PLE) is a condition in which excess loss of proteins occurs through the gastrointestinal tract due to different etiologies. It should be suspected in patients with low serum proteins and in whom other causes of hypoproteinemia have been ruled out.[1]

Histopathology depends on the underlying cause. For example, In protein-losing enteropathy caused by Crohn disease, we can see granulomas and acute and chronic inflammation of the colonic wall. Crypt abscesses, crypt branching, increased lamina propria cellularity, basal plasmacytosis, basal lymphoid aggregates are present in ulcerative colitis. Various other mucosal abnormalities can be seen depending upon the etiology.[7]

The clinical features of protein-losing enteropathy depend on the underlying etiology. Loss of serum proteins leads to decreased oncotic pressure in capillaries, which, in turn, leads to peripheral edema (most common presenting symptom) due to transudation of fluids from capillaries to the subcutaneous tissue. Patients can also present with abdominal distension due to ascites and pleural effusions. In primarily gastrointestinal causes of protein loss, they can have diarrhea, bloating, abdominal pain, etc. This condition can cause loss of immunoglobulins and lymphocytes, which cause immunocompromised state leading to frequent infections, and also patients can get opportunistic infections. Patients with protein loss due to cardiac diseases can present with symptoms of heart failure like pitting edema, pleural effusion, shortness of breath, elevated jugular venous pressure.

Diagnosis of protein-losing enteropathy should be suspected in patients with hypoproteinemia once the other common causes like severe malnutrition, nephrotic syndrome, or chronic liver diseases have been ruled out. Since the protein loss in PLE occurs independent of their molecular weight, these patients have low albumin and low globulins in their serum. If there are isolated low serum albumin and normal serum globulins, then alternative causes should be considered.

Treating the underlying pathology is the mainstay of treatment. Besides this, dietary modifications also play a critical role in the management of protein-losing enteropathy. Diet rich in protein and medium chain triglycerides and low in fat is considered the best diet in this condition. Patients may require 2 to 3g/kg/day of protein. Replacement of micronutrients, electrolytes, and vitamin deficiencies should occur as appropriate.

Complications depend mostly on the underlying disease causing protein-losing enteropathy. Patients with Inflammatory bowel disease can develop colon cancer, anemia, primary sclerosing cholangitis, and many other complications. PLE due to ulcerative diseases can have a perforation of ulcer and peritonitis. Patients with Clostridium difficile colitis can develop toxic megacolon. Patients can develop a deficiency of micronutrients and vitamins (particularly fat-soluble vitamins). Due to the loss of immunoglobulins and lymphocytes, patients get prone to recurrent and opportunistic infections.

If the clinician suspects protein-losing enteropathy in any patient consultation with a gastroenterologist should be done as the first step to start the work up. Once the diagnosis is confirmed, then further consultations can be done depending on the underlying cause. If a heart condition is the primary cause of PLE, then the patient should be referred to a cardiologist for optimization of heart failure and other cardiac causes. If the workup reveals malignancy, then referral to oncologist should be made.

Protein-losing enteropathy is a pathological condition in which there is an increased loss of proteins through the gastrointestinal tract, which leads to low serum proteins. Most patients present with peripheral edema. Many diseases can lead to PLE. Appropriate consultants should be seen depending on the primary cause. The prognosis depends on the underlying condition causing PLE.

Treatment of underlying cause is the best treatment for protein-losing enteropathy. There is an equal loss of albumin and globulin in this condition. It can leads to immunodeficiency due to the loss of immunoglobulins and lymphocytes and make the patients prone to opportunistic infections. A1AT clearance if the primary test used for diagnosis of PLE.