Internal Medicine

(Wang) #1

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
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