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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.