Internal Medicine

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

1228 Protein-Losing Enteropathy Pruritus

General Measures

■Identify and treat the primary disease by appropriate study of intes-

tine, colon, heart, and large abdominal or thoracic veins

specific therapy

■If PLE persists, prednisone 10–20 mg/day (30 days, gradual taper)

may reverse the protein loss, regardless of cause

■Repeat courses of prednisone may be necessary

follow-up

■Weekly body weights, monthly examinations, including estimation

of pleural fluid (chest X-rays), ascites (measure abdominal girth,

abdominal ultrasound), extent of residual pedal edema

■Monthly measurement of serum albumin

complications and prognosis

■Varies with underlying disease; mechanical correction, when possi-

ble, may be curative.

■Intermittent prednisone therapy may be required over the long-term

PRURITUS

JEFFREY P. CALLEN, MD

history & physical

Signs & Symptoms

■Pruritus is the symptom of itching

■Scratching may result in excoriations, rubbing may result in licheni-

fication

■Pruritus may be a symptom that accompanies a primary skin disor-

der, or may reflect an underlying systemic disease

■Pruritus may be localized or generalized

tests

Laboratory

■Basic blood studies:

➣CBC, comprehensive metabolic panel, hepatic enzymes (partic-

ularly alkaline phosphatase), thyroid panel, hepatitis C antibody,

HIV test

➣Skin biopsy may be helpful in diagnosis of dermatitis herpeti-

formis, mycosis fungoides