Intestinal Lymphangiectasia
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INTESTINAL LYMPHANGIECTASIA 1.
CHIEF COMPLAINT •Intestinal lymphangiectasia
2. 3. 4.
HPI ROS SYMPTOMS •Edema •Nonbloody diarrhea •Steatorrhea •Malabsorption •Lymphocytopenia •Hypogammaglobulinemia •Ascites •Chylous pleural effusions •Growth retardation
5.
HISTORY •FAMILY HISTORY o Heart diseases o Diabetes o Hypertension o Endometriosis •SOCIAL HISTORY •PAST MEDICAL HISTORY o Abdominal or retroperitoneal carcinoma o Lymphoma o Constrictive pericarditis o Congestive heart syndrome o Chronic pancreatitis o Scleroderma o Celiac disease o Retroperitoneal fibrosis o Intestinal endometriosis o Sclerosing mesenteritis o Lymphenteric fistula •SURGICAL HISTORY
•CHRONIC CONDITIONS o Cardiac diseases o Crohn disease o Mesenteric tuberculosis o Sarcoidosis o Whipple disease o Systemic lupus erythematosus (SLE) 6.
ALLERGY
7.
PHYSICAL EXAMINATION
•Peripheral edema •Macular edema on funduscopic examination •Clubbing of the fingers •Periostosis •Skin changes. 8.
SPECIFIC DATA LIKE GRADING ETC
9. TEST TO BE ORDERED •CBP •Serum electrolytes •Serum albumin •Serum albumin globulin ration •Immunological assay •Stool Alpha1-antitrypsin study •Double-contrast radiographs of the small bowel •Ultrasound •CT scans •Endoscopy •Small bowel enteroscopy •Capsule endoscopy 10. ASSESSMENT /PLAN •Dietary modifications include a low-fat diet and substitution of long-chain fatty acids with medium-chain fatty acids. •A logical step might be to decrease the amount of salt intake •Treatment of patients with secondary causes of intestinal lymphangiectasia involves management of the underlying disease.
•Postural drainage by elevating the affected extremities above the
level of the heart is easy to promote compliance. Surgical Care •Gastrectomy •Correction of a lymphenteric fistula •Pericardiectomy •Surgical resection of intestinal lymphangiectasia 11. EDUCATION o Encourage patients to maintain an active lifestyle as much as their disease allows. o Modify the patient's diet to reduce intake of long-chain fatty acids, substituting short-chain and medium-chain fatty acids. 12. MEDICATION •Octreotide •Tranexamic acid 13. FOLLOW-UP
CHIEF COMPLAINT •Intestinal lymphangiectasia
2. 3. 4.
HPI ROS SYMPTOMS •Edema •Nonbloody diarrhea •Steatorrhea •Malabsorption •Lymphocytopenia •Hypogammaglobulinemia •Ascites •Chylous pleural effusions •Growth retardation
5.
HISTORY •FAMILY HISTORY o Heart diseases o Diabetes o Hypertension o Endometriosis •SOCIAL HISTORY •PAST MEDICAL HISTORY o Abdominal or retroperitoneal carcinoma o Lymphoma o Constrictive pericarditis o Congestive heart syndrome o Chronic pancreatitis o Scleroderma o Celiac disease o Retroperitoneal fibrosis o Intestinal endometriosis o Sclerosing mesenteritis o Lymphenteric fistula •SURGICAL HISTORY
•CHRONIC CONDITIONS o Cardiac diseases o Crohn disease o Mesenteric tuberculosis o Sarcoidosis o Whipple disease o Systemic lupus erythematosus (SLE) 6.
ALLERGY
7.
PHYSICAL EXAMINATION
•Peripheral edema •Macular edema on funduscopic examination •Clubbing of the fingers •Periostosis •Skin changes. 8.
SPECIFIC DATA LIKE GRADING ETC
9. TEST TO BE ORDERED •CBP •Serum electrolytes •Serum albumin •Serum albumin globulin ration •Immunological assay •Stool Alpha1-antitrypsin study •Double-contrast radiographs of the small bowel •Ultrasound •CT scans •Endoscopy •Small bowel enteroscopy •Capsule endoscopy 10. ASSESSMENT /PLAN •Dietary modifications include a low-fat diet and substitution of long-chain fatty acids with medium-chain fatty acids. •A logical step might be to decrease the amount of salt intake •Treatment of patients with secondary causes of intestinal lymphangiectasia involves management of the underlying disease.
•Postural drainage by elevating the affected extremities above the
level of the heart is easy to promote compliance. Surgical Care •Gastrectomy •Correction of a lymphenteric fistula •Pericardiectomy •Surgical resection of intestinal lymphangiectasia 11. EDUCATION o Encourage patients to maintain an active lifestyle as much as their disease allows. o Modify the patient's diet to reduce intake of long-chain fatty acids, substituting short-chain and medium-chain fatty acids. 12. MEDICATION •Octreotide •Tranexamic acid 13. FOLLOW-UP
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