Protein loss gastrointestinal syndrome

　　The exact mechanism of protein loss from the gastrointestinal tract is not clear, but it is currently倾向于a multifactorial theory, believing that it is related to various diseases:

　　1. Diseases with abnormal gastrointestinal mucosal epithelium:Include hypertrophic gastritis, gastric cancer, ulcerative colitis, regional enteritis, Crohn's disease, colorectal cancer, or any other inflammatory and ulcerative lesions, which can allow plasma proteins to渗入 intestinal lumen from the diseased mucosa. If this exceeds the compensatory capacity of the liver, hypoproteinemia is formed.

　　2. Diseases with abnormal gastrointestinal or systemic lymphatics:Include chest duct lymphatic obstruction, constrictive pericarditis, congestive heart failure, poor intestinal lymphatic drainage, and lymphangiectasia of the small intestine. Hypoproteinemia in constrictive pericarditis and congestive heart failure is mainly due to increased central venous pressure, which hinders the return of lymph in the thoracic duct, leading to the loss of intestinal protein. Lymphangiectasia of the small intestine may be a congenital defect, and the rupture of dilated lymphatics can cause plasma proteins and lymphocytes to be lost from the intestines.

　　3. Diseases with increased capillary permeability:Diseases such as colonic polyps with capillary dilation, allergic gastrointestinal diseases, and gastrointestinal mucosal metabolic disorders all have increased capillary permeability, leading to protein loss, such as adult celiac disease.

　　4. Hypoproteinemia can have four pathophysiological changes:(1) Decreased protein synthesis due to acquisition; (2) Decreased protein synthesis due to congenital causes; (3) Increased protein catabolism; (4) Excessive protein loss from urine and feces.

　　1. Pulmonary infection:It is mainly caused by the expansion of small intestinal lymphatics, which often leads to the loss of immunoglobulins and abnormalities in cell immunity, and the weakening of the lymphocytes of plant hemagglutinin return to the ancestral phenomenon. Symptoms include cough, sputum, difficulty breathing, fever, fatigue, and so on.

　　2. Tetany of the hands and feet:It is caused by the loss of calcium. The symptoms include wrist flexion, finger extension, thumb close to the palm, and toes stiff. The sole is slightly bent, forming an arch.

　　3. Immune function decline:It is highly susceptible to bacterial, viral, and fungal infections due to the loss of a large amount of protein.

　　4. Disruption of water and electrolyte metabolism.

　　Due to the loss of plasma proteins, especially albumin, leading to a decrease in colloidal osmotic pressure and secondary increase in aldosterone, causing sodium and water retention, patients may experience general edema, especially in the lower limbs. In addition, there may be pleural effusion, ascites, weight loss, anemia, etc. Children may have developmental disorders. Gastrointestinal symptoms may include loss of appetite, nausea, vomiting, diarrhea, and abdominal pain, etc. The loss of calcium can induce tetany. The expansion of small intestinal lymphatics often leads to the loss of immunoglobulins and abnormalities in cell immunity, and the lymphocytes of plant hemagglutinin return to the ancestral phenomenon is weakened, thus it is easy to occur pulmonary infection.

　　1. Pay attention to the prevention and timely treatment of diseases that can cause the disease, such as gastrointestinal inflammation and other lesions, and pay attention to the prevention and treatment of protein loss and hypoproteinemia.

　　2. Reduce the intake of irritant foods and drugs that damage the intestines, reduce mental burden and mental trauma, and avoid the occurrence of infectious diseases. Eat less high-fat foods to avoid exacerbating the burden on the gastrointestinal tract due to difficult digestion, such as eating less high-fat fast food.

　　1. 131I-PVP

　　PVP (polyvinylpyrrolidone) is a macromolecular substance that is rarely absorbed in the digestive tract. After intravenous injection of 10 to 15 microcuries, stool without urine for 4 days is collected for measurement: normal individuals excrete only 0% to 1.5%, while patients with the disease can increase excretion to 2.9% to 32.5%. In recent years, some people have used 59Fe-dextran instead of 131I-PVP.

　　2. 51Cr-albumin and 51Cr-transferrin

　　25 microcuries of 51Cr-radiolabeled albumin is intravenously injected, and the stool without urine for 4 days is collected. Normal excretion is 0.1% to 0.7%, while patients with the disease excrete 2% to 40%. Recently, it has been reported that intravenous injection of 10 microcuries of 51Cr- transferrin is more effective. Since the labeled albumin or transferrin is almost not absorbed from the gastrointestinal tract and not secreted from normal digestive fluids (such as saliva, gastric juice), it is very valuable for understanding the loss of gastrointestinal protein. Since 51Cr can be excreted in urine, it is essential not to mix with urine when collecting stool specimens.

　　3. In addition, X-ray gastrointestinal barium meal examination, lymphangiography, and endoscopic examination can be performed to assist in diagnosis.

　　First, therapeutic diet for protein loss gastrointestinal syndrome (the following information is for reference only, detailed information needs to be consulted with a doctor)

　　1. Braised water chestnut meat with tofu:200 grams of fresh water chestnut meat (rubbed off the thin skin and washed), 100 grams of fresh mushrooms (cut off the stems, washed), 350 grams of soft tofu, salt, monosodium glutamate, and sesame oil to taste. Cut each water chestnut into 4 pieces, cut the mushrooms into 4 pieces, and cut the tofu into small pieces for later use. Place a wok over high heat, heat the oil, when it reaches 160°C, add the water chestnut meat to the pot and fry for a while, then remove and drain the oil. Heat the wok again, when the oil reaches 160°C, add ginger slices and stir-fry until fragrant, add the tofu and fry for a while, add water, add the water chestnut meat and mushrooms, add salt, cover and cook for 10 minutes, season with monosodium glutamate, pour in sesame oil, and serve. It is suitable for mealtime consumption and is beneficial for invigorating the stomach, benefiting the middle.

　　2. Dried date duck:1 duck weighing about 750 grams (killed, feathers and internal organs removed, beak and claws cut off, the duck's gizzard cleaned and刮 clean, the duck meat washed with warm water, drained and set aside), 60 grams of dried dates (cleaned, soaked in warm water for 2 hours), scallions, ginger, cooking wine, salt, and monosodium glutamate to taste. Place a wok over high heat and heat the oil to 200°C, add the duck meat, dried dates, ginger slices, scallion slices, cooking wine, salt, and simmer over low heat for 2 hours, remove the duck meat, cut into pieces, arrange in the shape of a duck, add the dates, remove the scallion slices and ginger slices from the pot, add monosodium glutamate, thicken with wet starch, pour over the duck meat, and it is ready to eat. It is suitable for mealtime consumption and is beneficial for nourishing the stomach, benefiting the heart and spleen, and replenishing qi and producing body fluid.

　　3. Ingredients for winter melon soup:50 grams of ham, 250 grams of winter melon, salt and monosodium glutamate to taste. Wash 50 grams of ham with warm water, place in a bowl, steam for 30 minutes; peel, remove the seeds and flesh of the winter melon, wash clean. Cut the ham into thin slices 3 cm long and 1.5 cm wide, and cut the winter melon into strips 4 cm long and 1.5 cm wide. Place the winter melon pieces in the pot, add sufficient water, bring to a boil over high heat, then reduce to medium heat, cook until 70% done, add the ham slices and salt, cook until the winter melon is done, season with monosodium glutamate and it is ready to eat. It is beneficial for nourishing the stomach, benefiting the spleen, and promoting diuresis.

　　4. Braised carp with ginseng and bamboo shoots:100 grams of fresh ginseng; 20 grams of Hedysarum polybotrys slices, soaked in water for 1 hour; a carp weighing about 750 grams, cut open and cleaned, with gills, scales, fins, and internal organs removed; 30 grams of mushrooms soaked in water to expand; seasonings to taste. Make diagonal cross cuts on both sides of the fish; slice the fresh ginseng diagonally; cut the mushrooms in half. Place the wok over high heat, add peanut oil and heat to 160°C, fry the carp until golden brown, add cooking wine, then remove and drain the oil. In a wok over high heat, add lard and sugar and stir-fry to a date red color, then add scallions, garlic, add light stock, add the fried carp, add ginseng slices and Astragalus slices, bring to a boil and simmer over low heat until the soup thickens. Remove the fish and place it on a plate. Add the Astragalus slices, ginseng slices, and mushrooms to the pot, cook for a while, add salt, monosodium glutamate, soy sauce, thicken with wet starch, pour in lard, pour over the fish, and it is ready to eat. The ginseng slices can be eaten as well. It is suitable for mealtime consumption and is beneficial for replenishing the middle qi and benefiting the spleen and stomach.

　　5. Astragalus and Chicken Gizzards Porridge:12 grams of raw Astragalus, 10 grams each of raw Coix Seed and red bean, 7 grams of chicken gizzards powder, 1 piece of golden pomelo cake, 80 grams of glutinous rice. Boil the raw Astragalus in water for 20 minutes, take the juice, add Coix Seed, red bean, and glutinous rice to cook into porridge, and then add the chicken gizzards powder. It is beneficial to strengthen the stomach and supplement protein.

　　Secondly, what foods are good for protein-losing enteropathy?

　　1. Eat more vegetables and fruits rich in vitamin C.

　　2. Provide high-protein, high-fat, high-calorie, low-carbohydrate, low-fiber, and easily digestible foods. Pay attention to supplement various vitamins and minerals such as iron, potassium, sodium, and chlorine, which can be obtained from foods such as lean meat, fish, liver, whole wheat bread, potatoes, and peanuts.

　　3. Eat nutritious and easily digestible soft foods such as noodles, rice porridge, and milk for breakfast.

　　4. Meat, liver, kelp, mushrooms, spinach, and rapeseed can meet the daily iron requirement of 20 milligrams for adults under 50 years old.

　　Thirdly, what foods should be avoided for protein-losing enteropathy?

　　1. Eat less fried food: Because these foods are not easy to digest, they will increase the burden on the digestive tract, and eating too much will cause indigestion, and will also increase blood lipids, which is not good for health.

　　2. Eat less preserved food: These foods contain a lot of salt and certain carcinogens, and should not be eaten in large quantities.

　　3. Eat less cold and spicy food: Cold and spicy food with strong刺激性 has a strong stimulating effect on the mucous membrane of the digestive tract, which is easy to cause diarrhea or inflammation of the digestive tract.

　　4. Drink less alcohol and eat less spicy food such as chili and pepper.

　　5. Avoid acidic foods: Fruits with high acidity, such as pineapples, tangerines, oranges, etc.

　　It is mainly the treatment of the primary disease. When there is an intestinal bacterial infection, antibiotics should be used; when there is a malignant tumor in the intestines, anticancer agents or surgical resection should be used; for some immunological变态反应性疾病，immunosuppressants or corticosteroids can be used. Symptomatic treatment includes low-salt diet and diuretics, and for malnourished patients, the corresponding nutrients lacking can be supplemented. Intravenous albumin administration has certain efficacy, and whole blood transfusion can be given when necessary.