Makindo Medical Notes.com

Long-term complications of PLE include severe malnutrition, recurrent infections due to immunoglobulin loss, thromboembolic events due to hypoproteinemia, and progressive organ dysfunction (especially in cases involving cardiac or lymphatic causes"

About

• Abnormal serum protein loss e.g. Albumin across the intestinal mucosa
• Exceeds normal protein synthesis

Aetiology

• Lymphatic obstruction
• Abnormal Mucosal integrity
• Localised ulceration

Causes

• Crohn's disease and Ulcerative colitis
• Menetrier's disease affects the gastric mucosa
• Coeliac disease, Lymphangiectasis
• Amyloidosis, Pseudomembranous colitis
• Tuberculosis, Sarcoid
• Whipple's disease, AIDS

Clinical

• Anasarca and oedema, weight loss, diarrhoea
• Cachexia in extreme cases, Fat soluble vitamin deficiencies
• Recurrent Infections: Due to hypogammaglobulinemia resulting from loss of immunoglobulins.

Investigations

• Serum Albumin and Total Protein: are low.
• Faecal Alpha-1 Antitrypsin Clearance Test: high indicate protein loss via the GI tract.
• Serum Immunoglobulins: May show hypogammaglobulinemia, particularly IgG.
• Lymphocyte Count: May show lymphopenia in cases of intestinal lymphangiectasia or lymphatic obstruction.
• CT or MRI of the Abdomen: tumours, lymphangiectasia, or retroperitoneal fibrosis.
• Echocardiography: exclude constrictive pericarditis as a cause of PLE.
• Lymphangiography: where lymphatic obstruction or malformation is suspected.
• Upper Endoscopy and Colonoscopy with Biopsy: IBD, coeliac disease, or malignancies.
• Capsule Endoscopy: Useful for evaluating the small intestine

Management

• Nutrition and Protein supplementation: High-protein diet or supplementation with albumin infusions in severe cases. Vitamin and Mineral Replacement: fat-soluble vitamins (A, D, E, K), calcium, and magnesium as needed. TPN may be necessary in severe cases or when oral intake is insufficient.
• Coeliac Disease: Strict gluten-free diet.
• Inflammatory Bowel Disease: Immunosuppressants, biologics, and anti-inflammatory agents.
• Intestinal Lymphangiectasia: A low-fat diet supplemented with medium-chain triglycerides (MCTs) to reduce lymphatic pressure. Octreotide may also be beneficial.