History

The most common presenting symptom of protein-losing enteropathy is swelling of the legs or other areas due to peripheral edema secondary to decreased plasma oncotic pressure, with subsequent transudation of fluid from the capillary bed to the subcutaneous tissue.

If the protein-losing gastroenteropathy is related to other systemic diseases (eg, congestive heart failure, constrictive pericarditis, connective-tissue disease, amyloidosis, protein dyscrasias), the clinical presentation may be that of the primary disease process.^[21]

Patients with primary gastrointestinal disease present with diarrhea with or without bleeding, abdominal pain, and/or weight loss.

Along with a loss of proteins, a significant loss of immunoglobulins and lymphocytes can also occur. This may lead to the development of an immunological deficiency, predisposing to infections.^[2]

Physical Examination

Physical examination reveals peripheral edema and, in rare cases, anasarca. Evidence of the underlying medical problem (eg, cardiac disease, amyloidosis) may exist.^{[5, 22]}

If a primary gastrointestinal etiology exists, the abdominal examination findings may be unremarkable. Hepatosplenomegaly may be present, depending on the underlying process.

Differential Diagnoses

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Protein-Losing Enteropathy Clinical Presentation

History

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