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