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🌟 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.
