Angiodysplasia

Question 1

What is angiodysplasia?

Answer 1

Most common vascular abnormality of the GI tract.
Caused by formation of arteriovenous malformations between previoulsy healthy blood vessels. Most commonly in caecum and ascending colon.

Second most common cause of rectal bleeding in >60 yrs
Most common cause of bleeding from small bowel

Question 2

What are the two types of angiodysplasia?

Answer 2

Acquired

Congenital

Question 3

What are the clinical features of angiodysplasia?

Answer 3

Painless Rectal bleeding and anaemia
Asymptomatic
Acute haemorrhage

Could have haematemesis or melena- upper GI
Hamatochezia - lower GI

Question 4

What are the differential diagnosis for angiodysplasia?

Answer 4

Oesophageal varices
GI malignacies
Diverticular disease
Coagulopathies

Question 5

What are the investigations for angiodysplasia?

Answer 5

Bloods

Imaging:
Upper GI endoscopy or colonoscopy depend on symtoms

Small bowel leaks - wireless capsule endoscopy

Overt angiodysplasia bleed - mesenteric angiography - radionuclide scanning, CT scanning or MRI.

Question 6

What is the mangement of angiodysplasia?

Answer 6

ABCDE

Persistant severe cases:

• endoscopic - first line - argon plasma coagulaion
• mesenteric angiography - small bowel lesions - super-selective cauterisation and embolization of the vessel. Can be used in other places if endoacopic failed or not sutible.

Question 7

What are the indictions for surgical resection in angiodysplasia?

Answer 7

Continuation of severe bleeding - despite endoscopic and angiographic management
Severe acute life-threatening GI bleeding
Multiple angiodysplastic lesions that cant be treated medically

Question 8

What are the complications of angiodysplasia treatments?

Answer 8

Re-bleeding post-thearpy

Endoscopic - small risk of bowel perfortion

Mesenteric angiography - haematoma, arterial dissection, thrombosis and bowel ischaemia