Chapeter 62- Amyloidosis

Question 0

Classification of amyloidosis

Answer 0

AL-> immunoglobulin light chain amyloidosis:

1. Primary amyloidosis
2. Multiple myeloma

AA-> serum amyloid A deposition

1. Rheumatoid arthritis
2. familial Mediterranean fever
3. Chronic infection or inflammation

Question 1

What is the treatment for amyloidosis?

Answer 1

Diuretics
Dyalisis is end stage renal failure
Colchicine if cause is familial mediterranean fever
Melphalan and prednisone if AL amyloidosis b/c prolong survival

Question 2

What are the possible findings on physical exam for a patient with amyloidosis?

Answer 2

Depending on the system:

1. Cardio-> since restrictive cardiomyopathy –> elevated JVP, rapid Y descent. Since defective conduction–> EKG will show decreased amplitude of QRS waves and also atrioventricular block, also ask for bradycardia.
2. Neuro-> carpal tunnel syndrome, distal polyneuropathy, autonomic dysfunction (orthostatic hypotension, etc).
3. Renal-> renal tubular acidosis & nephrotic syndrome-> ask for blood in the urine.
4. Hematology-> factor X deficiency-> ask for bruising & periorbitsl echymosis
5. Rheumatology-> symmetrical arthritis
6. GI-> macroglossia, malabsorption syndrome, motility disorders,
7. Hepatic-> cholestasis and hepatomegaly