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