Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:19

Prostatitis Protein-Losing Enteropathy 1227

complications and prognosis

■Prostatic abscess (requires drainage – can be source of fever of

unknown origin), pyelonephritis, bacteremia, chronic pain, urinary

obstruction

PROTEIN-LOSING ENTEROPATHY

GARY M. GRAY, MD

history & physical

History

■Fatigue, pedal edema, ascites

■Associated history of intra-abdominal disease of stomach, intestine,

colon, lymph channels (especially lymphangiectasia) or functional

blockage of major abdominal or thoracic veins.

■Underlying heart disease (chronic heart failure, pericarditis, tricus-

pid valve regurgitation) or after transplantation of heart or liver

Physical

■Pitting edema of lower extremities; ascites and pleural effusions

tests

Basic Blood

■hypoalbuminemia (albumin usually <2.5 g/dl); lymphopenia,

hypogammaglobulinemia

Basic Urine

■none usually helpful; no proteinuria

Specific Diagnostic

■Increased fecal loss of macromolecules (alpha-1-antitrypsin) or

enhanced loss into hollow gut by scintigraphy (technetium-99m-

labeled) [Tc-99m]albumin; [Tc-99m]dextran

differential diagnosis

■Hypoabuminemia due to renal loss (proteinuria)

■Inadequate liver synthesis of albumin (especially in cirrhosis)

■Generalized protein calorie malnutrition due to an intestinal disease

management

What to Do First

■Initial trial of fluid restriction and diuretics (often not successful)

■High protein diet