Makindo Medical Notes

🌟 Protein Losing Enteropathy (PLE) = excessive loss of proteins (albumin, Ig, clotting factors) via the GI mucosa. 💡 Clue: Unexplained hypoalbuminaemia + oedema with normal liver and kidney function → always think of PLE.

📖 About

• 🧬 PLE occurs when protein loss via the gut exceeds the liver’s ability to synthesise new protein.
• ⬇️ Leads to hypoalbuminaemia, oedema, immune dysfunction, and nutritional deficiency.
• Not a single disease → a syndrome secondary to GI, lymphatic, or systemic pathology.

⚙️ Aetiology & Mechanisms

• Lymphatic obstruction: ↑ lymphatic pressure → protein-rich lymph leaks into gut (e.g., intestinal lymphangiectasia, constrictive pericarditis).
• Mucosal injury: Inflammation/ulceration damages gut barrier (e.g., IBD, infections).
• Ulceration/erosions: Focal mucosal loss (e.g., TB, Whipple’s, amyloidosis).

🔑 Causes (Common Associations)

• 🩸 Inflammatory Bowel Disease (UC, Crohn’s)
• 🍽️ Coeliac disease
• 🌀 Intestinal lymphangiectasia
• 🧾 Menetrier’s disease (giant gastric folds)
• ⚡ Amyloidosis, Sarcoid, TB, Whipple’s
• 🦠 Pseudomembranous colitis (C. diff)
• 🧑‍⚕️ AIDS / advanced HIV

🩺 Clinical Features

• 💧 Anasarca: Generalised oedema (hypoalbuminaemia).
• ⚖️ Weight loss + chronic diarrhoea.
• 🥀 Cachexia in advanced disease.
• 🧃 Fat-soluble vitamin deficiency (A, D, E, K): coagulopathy, rickets, neuropathy.
• 🛡️ Recurrent infections: loss of IgG → hypogammaglobulinaemia.
• 🩸 Thromboembolism: reduced antithrombin III → hypercoagulable state.

🔎 Investigations

• 💉 Serum proteins: ⬇️ albumin & total protein.
• 🧪 Faecal α-1 antitrypsin clearance: gold standard for gut protein loss.
• 🛡️ Immunoglobulins: hypogammaglobulinaemia common.
• 🧾 Lymphocyte count: lymphopenia in lymphangiectasia.
• 📸 CT/MRI: lymphatic obstruction, intestinal changes.
• 🫀 Echo: exclude constrictive pericarditis.
• 🔬 Endoscopy + biopsy: for IBD, coeliac, amyloid, lymphoma.
• 📹 Capsule endoscopy: small bowel mucosal disease.

⚕️ Management

• 🍽️ Nutrition: high-protein diet, MCT (medium-chain triglycerides) in lymphangiectasia.
• 💉 Albumin infusions: for severe oedema.
• 🧃 Vitamin replacement: A, D, E, K + minerals (Ca, Mg).
• 🚫 Avoid triggers: strict gluten-free diet in coeliac, stop NSAIDs in IBD.
• 💊 Underlying disease control:
  • IBD → steroids, biologics
  • Lymphangiectasia → diet ± octreotide
  • Infection → targeted antibiotics
• 🧑‍🔬 Immunoglobulin replacement: in recurrent infections.
• ✂️ Surgery: for localised tumours or obstruction.

⚠️ Long-term Complications

• 🥀 Severe malnutrition and cachexia
• 🛡️ Recurrent infections (Ig loss)
• 🩸 Thrombosis (loss of antithrombin III, protein C/S)
• 🫀 Progressive organ dysfunction (esp. cardiac/lymphatic PLE)

💡 Teaching Pearl: In unexplained oedema + low albumin with normal liver & kidney tests, always consider Protein Losing Enteropathy. Mnemonic = "LOSS" → Loss of Albumin, Immunoglobulins, Lymphocytes, Fat-soluble vitamins.