AMY DA site - i can identify - Video 3

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.