Protein Losing Gastroenteropathy

  • – 2-5% of total body degradation of albumin occur through GI tract loss
  • – In severe protein-losing GI diseases, this enteritic protein loss may extend upto 60% of the total albumin pool
  • – Under physiologic conditions, most endogenous proteins found in the lumen of GIT are derived from sloughed enterocytes and from pancreatic and biliary secretions
  • Total albumin pool in
  •           • Women: 3.9 g/kg
  •           • Men: 4.7 g/kg
  • – Half Life of Albumin: 15-33 days
  • – Hepatic Albumin synthesis rate: 0.15 g/kg/day
  • – In nephrotic syndrome, selectively low molecular weight protein such as albumin is lost
  • – In Protein losing gastroenteropathy, the loss of serum protein is irrespective of molecular weight. so albumin, immunoglobulin, insulin clotting factors are lost
  • – Hypoalbuminemia is common in protein lossing gastroenteropathy and results when there is imbalance between hepatic albumin synthesis (which is limited and can only increase by 25%) and albumin loss

 

  • Clinical features:
    • – Hypoproteinemia and edema are the principal clinical manifestation
    • – Pleural, pericardial effusion, malnutrition are commonly seen
    • – Hypoproteinemia manifests by decrease in serum
    •                   • Albumin
    •                   • Immunoglobulin (IgA, IgM, but not IgE)
    •                   • Fibrinogen
    •                   • Lipoprotein
    •                   • α1 Anti trypsin
    •                   • Transferrin
    •                   • Cerulopolasmin
    • – Anasarca is rare
    • – Despite decreased gamma globulin levels, increased susceptibility to infection is uncommon
    • – Coagulation is unaffected
    • – Signs/symptoms of underlying disease
  • Disorders associated with protein losing gastroenteropathy:
    1. Disease without mucosal erosion or ulceration
    2. Disease with mucosal erosion or ulceration
    3. Diseases with lymphatic obstruction or elevated lymphatic pressure
  •       Investigations for protein-losing enteropathy
    • Patients with unexplained hypoproteinemia in the absence of proteinuria, liver disease and malnutrition should be investigated for evidence of protein losing gastroenteropathy
    • Choice of Investigations:
  •                   Treatment:
    • – Correction of the underlying disease
    • – High protein, low fat diet
    • Octreotide: to decrease intestinal secretion

     


Copyrights © 2020 Arefin | Gastroenterology | Developed by Chumbok IT