Intestinal amyloidosis: diagnosis

Diagnosis of amyloidosis of the intestine

The following symptoms can help in the diagnosis of intestinal amyloidosis:

1. The presence of the underlying disease, which leads to the development of amyloidosis of the intestine (tuberculosis, bronchiectatic disease, rheumatoid arthritis, etc.).
2. Persistent diarrhea resistant to antibacterial, astringent, absorbent and fixing agents (amyloidosis with predominant lesion of the small intestine).
3. Clinical picture of malabsorption syndrome (typical for amyloidosis with predominant involvement of the small intestine).
4. Presence of hepato- and splenomegaly, macroglossia.
5. Presence of symptoms of kidney damage (edema, proteinuria, microhematuria).
6. A significant increase in ESR, an increase in blood levels of a2-globulins, fibrinogen, beta-lipoproteins.
7. A positive complement binding test with the patient's serum, an amyloid protein is used as an antigen.
8. A positive test of Bengold (absorption of 60% or more of the conhorot injected into the vein) and a test with methylene blue.
9. Biopsy of the gums, rectum mucosa, skinny and duodenal ulcer and detection in amyloid biopsies. This is the most important and reliable method of diagnosis.

Laboratory and instrumental data

1. General blood analysis. An iron deficiency hypochromic anemia can develop with a marked malabsorption syndrome.
2. Coprologic analysis. With the development of malabsorption syndrome, steatorrhea is observed, possibly the discovery of creatorrhoea, undigested food pieces.
3. Blood chemistry. It reveals hyperglobulinemia, often an increase in the content of a _2- globulin. With the development of malabsorption syndrome, hypoproteinemia, hypocalcemia, sometimes a tendency to hypoglycemia, hyponatremia, and gepocholesterinemia are revealed.
4. Investigation of the suction function of the small intestine reveals impaired absorption of various substances (samples with galactose, D-xylose, etc.).
5. X-ray examination of the intestine. Characterized by a prolonged delay of contrast in the intestine; flatulence; dilatation of the small intestine (with paralytic obstruction); thickening and stiffness of the walls of the small intestine; point defects of the mucosa in the form of multiple barium spots 1-2 mm in diameter; possible detection of narrowing of the lumen of the small intestine; sometimes mucosal atrophy is observed.
6. Laparoscopy. Ischemia of various segments of the small and large intestine, subserous hemorrhages, thickening of intestinal walls are defined.
7. Recto-manoscopy and colonoscopy. Stiff wall, hemorrhages, ulcers, and sometimes polypoid growths are found.
8. Histological examination of biopsy specimens of lean, 12 duodenum, rectum, gums. In biopsies, amyloid is detected perivascularly in the mucosa, submucosal and muscle layers and along the course of the reticular and collagen fibers, as well as the expansion and compaction of the villi.

[1], [2], [3], [4], [5], [6], [7], [8], [9]