Amyloidosis - a systemic disease with lesionsmany different organs and tissue structures, characterized by the disturbance of protein metabolism and extracellular deposition in these complex protein-polysaccharide complex.
The symptoms of amyloidosis gastrointestinal
The defeat of the digestive system found atany form of amyloidosis, especially of some of its departments (language - macroglossia, intestines, liver). In most cases, the defeat of the digestive system is just one of the many locations of the process (at the same time there is a renal amyloidosis, skin, skeletal muscles, nervous system and other organs and tissues).
When amyloidosis is characterized by esophageal dysphagia(Swallowing disorder) if swallowed thick and dry food, especially when eating, lying down, appearance regurgitation. When X-ray esophagus gipotonichen study peristalsis weakened, if a patient study in a horizontal position barium suspension of long delays in the esophagus. Complications: amyloid ulceration of the esophagus and esophageal bleeding.
Amyloidosis of the stomach is usually combined with amyloidosis of the intestine and other organs. The manifestations of amyloidosis of the stomach:
- after eating a feeling of heaviness in the epigastric region
- X-ray examination - smoothed the folds of mucous membrane, the weakening of peristalsis and evacuation of the contents of the stomach
Complications of the disease is amyloid plaguesstomach, stomach bleeding, perforation of the ulcer. The differential diagnosis spend with chronic gastritis, gastric ulcer, rarely - tumor. Crucial have biopsy data (identification amyloidosis).
intestinal amyloidosis - frequent localization of thisdisease. It manifests a sense of discomfort, heaviness, dull or less moderate spastic abdominal pain, stool disorders - constipation or persistent diarrhea.
In the study feces reveals the explicitsteatorrhea, amiloreyu, creators - a substance that normally absorbed in the intestine. In blood observed anemia, leukocytosis (increased white blood cell count), increased erythrocyte sedimentation rate, hypoproteinemia (reduction of the concentration of proteins), hyponatremia (decrease in sodium concentration), hypocalcemia (decreased calcium concentration).
Special research methods revealviolation of membrane digestion and absorption in the intestine. When X-ray is characteristic deployed ( "vzdybpennost") intestinal loops, thickened folds, and flattening of intestinal mucosa relief, slowing or speeding up the passage of barium suspension through the intestines.
A biopsy of the mucous membrane of small and large intestinesIt confirms the diagnosis and allows to make a differential diagnosis with enteritis and colitis, especially ulcerative colitis. Isolated tumor intestinal amyloidosis occurs under the guise of the tumor (pain, ileus) and is usually found already on the operating table. Complication - severe hypoproteinemia due to malabsorption processes in the gut, polyhypovitaminosis, narrowing of the intestinal lumen, amyloid ulcers, intestinal bleeding, perforation.
Liver Amyloidosis occurs relatively frequently. Characterized by an increase in liver and seal palpation edge of her smooth, painless. Often develops ascites - fluid accumulation in the abdominal cavity. Less common are pain in the right upper quadrant, dyspeptic symptoms, splenomegaly, jaundice, hemorrhagic syndrome.
Laboratory studies have determined a changeprotein-sediment samples, hypercholesterolemia (increased levels of cholesterol in the blood), in some cases - giperbiliru-Binh (increased bilirubin levels), elevated alkaline phosphatase, aminotransferases (ALT, AST) serum positive test with bromsulfaleinom. Crucial in the diagnosis of a hepatic biopsy. Complications - hepatic insufficiency.
Amyloidosis diagnosed pancreasrarely (occurs in the guise of chronic pancreatitis). For the disease characterized by a dull pain in the left upper quadrant, dyspeptic symptoms, pancreatogenic diarrhea, steatorrhea. Investigation reveals duodenal contents exocrine pancreatic insufficiency. In severe cases, secondary diabetes develops.
The diagnosis of amyloidosis of the digestive system. Of great importance is the identification of lesions of other organs and systems - kidney, heart, skin, spleen. The most reliable method for diagnosing amyloidosis is an organ biopsy in punctate, which detect clumps of amyloid staining sections of Congo red, methylene or gentian violet. In the secondary form of the disease it is important to identify chronic disease, which is usually complicated by amyloidosis (tuberculosis, bronchiectasis, empyema, and so on. D.).
Applied also functional clinical trials: with congo red and methylene blue (rapid disappearance of colors by intravenous administration of the serum amyloid due to the fixing and allocation of a sharp decline in their kidneys in the urine). However, primary amyloidosis they give inconsistent results. The diagnosis of primary amyloidosis is based on a thorough genetic analysis (identification of amyloidosis with relatives).
Laboratory blood tests revealincreased erythrocyte sedimentation rate, elevated levels of cholesterol and blood lipids. However, these changes are not specific for amyloidosis. The course of the disease progressing. As the disease progresses, patients receive a disability. The prognosis of amyloidosis unfavorable. Death occurs from exhaustion patients, renal, cardiac failure.
Treatment of amyloidosis digestive system
In secondary amyloidosis primarilynecessary treatment of the underlying diseases (tuberculosis, osteomyelitis, chronic empyema, etc.) after the treatment, which often disappear and symptoms of amyloidosis. Of specific means treating amyloidosis using immunosuppressants, corticosteroids. With early treatment may reverse the development of amyloidosis.
Symptomatic therapy directed at the receptionMultivitamins (intravenously or intramuscularly), diuretics (when expressed edema), plasma transfusion. When liver failure - appropriate symptomatic therapy. When intestinal amyloidosis, occurring with persistent diarrhea, astringents (bismuth nitrate basic, adsorbents). When the isolated tumor-amyloidosis of the gastrointestinal tract - surgical treatment.