Objectives:

• Recognize protein-losing enteropathy as a complication of gastroenteritis
• Identify other causes of protein-losing enteropathy and initiate treatment for this disorder

1		A 23-year-old female presents to your office complaining of weight gain over the past couple of weeks, despite the fact that she has had diarrhea. A number of other members of her sorority also had similar symptoms, but their symptoms have resolved while hers have continued. There have been documented rotavirus infections at the university and in the community. She has noticed some ankle swelling and a sloshing in her now protuberant abdomen. She has heard of premenstrual fluid retention but this is absurd! On physical exam, she has 2+ pitting edema to the knees bilaterally, a "fluid wave" in her abdomen, and decreased breath sounds at the bases bilaterally. Laboratory exam shows a normal CBC but a decreased albumin. Urinalysis is normal. The most likely diagnosis in this patient is:
			A)	Nephrotic syndrome.
			B)	GI-renal enteropathy.
			C)	Protein-losing enteropathy.
			D)	Cor pulmonale.
			E)	Rebound edema from diuretic use.
2		Which of the following cause protein-losing enteropathy?
			A)	Rheumatoid arthritis.
			B)	Viral gastroenteritis.
			C)	Collagenous colitis.
			D)	Amyloidosis.
			E)	All of the above.
3		The best treatment for this patient's disease is:
			A)	IV albumin to increase the osmotic content of the blood (which will reduce edema).
			B)	Oral levofloxacin.
			C)	Low-fat diet with the use of medium-chain triglycerides (fatty acids) to replace fats.
			D)	Low-carbohydrate diet.
			E)	Oral metronidazole plus ciprofloxacin.