Intestinal/Tube Disease

Question 0

Intestinal Lymphangiectasia

Answer 0

Primary: idiopathic lymphangiectasia
*can be assoc’d w/thoracic duct obstruction&raquo_space; chylothorax
Secondary: increased lymphatic pressure&raquo_space; hepatic congestion and lymphangiectasia&raquo_space; protein leaks into intestinal lumen
*can also cause pulmonary protein loss > pulm eff, chylothorax
cardiac dz w/high rt-sided pressure
lymphatic obstruction, lymphoma
malrotation
TB, sarcoidosis, retroperitoneal fibrosis
arsenic poisoning

Question 1

Protein-Losing Enteropathy

Answer 1

Intestinal Lymphangiectasia (primary/secondary)
Intestinal Mucosal Damage (infection/inflammatory)

Diagnosis: fecal α1AT level (sensitive and specific)

Question 2

Infectious causes of protein-losing enteropathy

Answer 2

Enteroinvasive bacteria: Shigella, Salmonella
Parasites: Giardia
C diff
H pylori
Bacterial overgrowth

Question 3

Inflammatory causes of protein-losing enteropathy

Answer 3

Gastric: 
   Menetrier Dz (gastric rugal hypertrophy)
   Eosinophilic gastroenteritis
Intestinal:
    Celiac dz
    Cow milk protein allergy
    Immunodeficiency
    Tropical sprue
    Radiation enteritis
    GVHD
    IBD
    Hirschsprung dz
    NEC
Vasculitis
    HSP
    SLE

Question 4

Polyposis Syndromes

Answer 4

FAP: AD, adenomatous polyps mostly colon, 95-100%&raquo_space; cancer

Peutz-Jeghers: AD, hamartomatous polyps mostly small bowel/stomach/colon, 2-3%&raquo_space; cancer but cause obstruction, bleeding, also pigmented macules, ovarian cysts, bony exostoses

Gardner: adenomatous polyps mostly colon, 95-100%&raquo_space; cancer, also skin/bone tumors/cysts, retinal pigmentation