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AMY DA site - i can identify - Video 3

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Chapters

  • 00:00:15
    AL amyloidosis is a systemic disease
  • 00:00:18
    and can affect gastrointestinal tract.
  • 00:00:22
    When patients have unexplained weight loss,
  • 00:00:26
    unexplained diarrhoea,
  • 00:00:29
    when patients have significant motility disorder
  • 00:00:33
    or have malabsorption along with other organ involvement,
  • 00:00:40
    one must look at systemic AL amyloidosis,
  • 00:00:44
    although being a rare diagnosis,
  • 00:00:47
    as a common diagnosis for different organ system involvement.
  • 00:00:54
    Patients with AL amyloidosis a lot of times will develop neuropathy;
  • 00:00:58
    an autonomic neuropathy or peripheral neuropathy.
  • 00:01:01
    They will develop trouble with gastric motility;
  • 00:01:05
    they will have trouble swallowing.
  • 00:01:07
    You know, they may develop constipation or diarrhoea
  • 00:01:10
    or they may develop alternating constipation and diarrhoea,
  • 00:01:12
    which is actually not uncommon—
  • 00:01:14
    a gastroenterologist sees that all the time.
  • 00:01:16
    And the astute gastroenterologist will realize that
  • 00:01:19
    this patient with GI dysmotility problems also has signs of heart failure.
  • 00:01:24
    You know, they have pedal edema and they have ascites
  • 00:01:28
    and they have exercise intolerance.
  • 00:01:30
    And they’ll start realizing, much like the other specialties,
  • 00:01:34
    that they’re dealing with a systemic problem that’s affecting multiple organs.
  • 00:01:45
    If AL amyloidosis is suspected by the gastroenterologist,
  • 00:01:49
    they could refer a patient to a haematologist oncologist
  • 00:01:54
    or they could also perform a flexible sigmoidoscopy
  • 00:02:00
    to obtain a rectal biopsy,
  • 00:02:02
    which is a very noninvasive procedure.
  • 00:02:06
    And those biopsies should always be stained
  • 00:02:10
    by Congo red for a presence of amyloid
  • 00:02:14
    and that’s how they will discover that the patient has
  • 00:02:17
    deposition of amyloid protein in their GI tract.
  • 00:02:20
    I think it’s important for the gastroenterologist to tell the pathologist
  • 00:02:24
    that, you know, my suspicion for AL amyloidosis is higher
  • 00:02:27
    because this patient has signs of other
  • 00:02:30
    you know, other organ system involvement,
  • 00:02:33
    because they may have signs of nephrotic syndrome.
  • 00:02:36
    They may have signs of worsening heart failure.
  • 00:02:38
    So, the GI doctor can guide the pathologist
  • 00:02:42
    so that they make sure to do Congo red staining to look for amyloidosis.