Impaired Nutrient Delivery to the General Circulation

A. Impaired Lymphatic Drainage

Intestinal lymphangiectasia can be congenital (malunion of intestinal lymphatics) or due to lymphatic obstruction (lymphoma, tuberculosis, sarcoidosis, retroperitoneal fibrosis, constrictive pericarditis, severe congestive heart failure). Increased pressure in lymphatics results in leak or rupture of lymph into the lumen with resulting loss of fat, protein (albumin, gammaglobulin) and lymphocytes.

Clinical sequelae include 1) fat and fat-soluble vitamin malabsorption, hypoproteinemia, lymphopenia and edema. Diagnosis can be made by intestinal biopsy and management includes a low fat diet supplemented with medium-chain triglycerides (MCTs) and fat-soluble vitamins as needed.

B. Protein-Losing Enteropathy

Individuals with malabsorption present often with hypoalbuminemia and edema. In many instances the low serum albumin is due to loss of protein into the gut lumen at the disease site. Protein loss in the gut may be due to many GI diseases with mechanisms as cited below.

Diagnosis is made by demonstrating increased amounts of alpha-1-antitrypsin in stool.

Category: Gastroenterology Notes