Angiodysplasia

Question 1

What is the most common vascular abnormality of GI tract?

Answer 1

• Angiodysplasia

Question 2

What is the Px of A?

Answer 2

• formation of arteriovenous malformations between previously healthy blood vessels
• common in caecum and ascending colon.

Question 3

What is the second commonest cause of rectal bleeding in those >60yrs?

Answer 3

• Angiodysplasia

Question 4

What are the 2 types of A?

Answer 4

• Acquired angiodysplasia
  
  • begins as reduced submucosal venous drainage in the colon due to chronic and intermittent contraction of the colon
  • rise to dilated and tortuous veins
  • loss of pre-capillary sphincter competency
  • formation of small arterio-venous communications
• Congenital angiodysplasia
  
  • hereditary haemorrhagic telangectasia (Rendu-Osler-Weber syndrome)

Question 5

What are the cf of A?

Answer 5

• Rectal bleeding
• anaemia
• Asymptomatic (incidental finding on colonoscopy)
• Painless PR bleeding (common)
• Acute haemorrhage

Question 6

What are the differentials for A?

Answer 6

• oesophageal varices (which may present with acute lower GI bleeding if large enough volume)
• GI malignancies
• diverticular disease
• coagulopathies

Question 7

What Ix would you order for A?

Answer 7

• Bloods
  
  • FBC*, U&Es, LFTs, and clotting
  • Group and Save or Crossmatch
• Imaging
  
  • upper GI endoscopy (if medically fit) and/or colonoscopy depending on the suspected site of bleeding
  • wireless capsule endoscopy
  • mesenteric angiography

Question 8

How many % of pt with A will present with major bleed?

Answer 8

• 10%

Question 9

How would you mx A?

Answer 9

• Limited bleeding, haemodynamically stable
  
  • Bed rest, IV fluids, Tranexamic acid
• Persistent or severe
  
  • Endoscopy + argon plasma coag
  • Mesenteric angiography + embolisation
• Bowel resection (small minority)

Question 10

What are the indications for bowel resection in A?

Answer 10

• Continuation of severe bleeding despite angiographic and endoscopic management
• Severe acute life-threatening GI bleeding
• Multiple angiodysplastic lesions that cannot be treated medically

Question 11

What are the cx of A?

Answer 11

• Endoscopic cx
  
  • very small risk of bowel perforation
• Mesenteric angiography
  
  • haematoma formation
  • arterial dissection
  • thrombosis
  • bowel ischaemia.