Angiodysplasia Flashcards
What is angio-dysplasia
The most common vascular abnormality of the GI tract that is responsible for approximately 6% of lower GI bleeds and 8% of upper GI bleeds
What is angio dysplasia caused by
It is caused by the formation of arteriovenous malformations between previously healthy blood vessels, most commonly in the caecum and ascending colon
What are the two types of angio dysplasia
Acquired
Congenital
What is Acquired angiodysplasia
begins as reduced submucosal venous drainage in the colon due to chronic and intermittent contraction of the colon, giving rise to dilated and tortuous veins. This results in the loss of pre-capillary sphincter competency and in turn causes the formation of small arterio-venous communications characterized by a small tuft of dilated vessels.
What is Congenital angiodysplasia
such as hereditary haemorrhagic telangectasia Rendu-Osler-Weber syndrome or Heyde’s syndrome.
What are the clinical features
Asymptomatic - only diagnosed at colonoscopy
Painless occult PR bleeding - majority of cases
Acute haemorrhage - ( 10-15% cases )
If angio dysplasia is in the upper GI then will have haematemesis and or melena.
Lower GI => haematochezia
What are the differential diagnosis of GI bleeding
Oesophageal varices
GI malignancies
Diverticular disease
How would you investigate AD With lab tests
FBC U&E LFTs COAG Group and save Cross match if transfusion needed
What imaging modalities are available for investigating GI bleeds
OGD
Colonoscopy
Wireless capsule endoscopy
Mesenteric angiography
What are the risk factors that lead to poor outcomes for patients with AD
Advancing age
Liver disease
Pts presenting with hypovolaemia
How would you treat a patient that is haemodynamically stable with AD
Bed-rest and IV fluid support, along with potential tranexamic acid, will provide sufficient management
How would you treat patient with severe AD
Endoscopy is the first line of treatment - argon plasma coagulation which involves subjecting a bleeding vessel to electrical current and argon
When would you use mesenteric angiography
When the AD is in the small bowel and you cant get to it from the OGD
Super selective catheterisation and emobilsation is used as the bleeding vessel can be identified by angiography.
What are the surgical indications for AD
Continuation of severe bleeding despite endoscopic management
Severe acute life threatening GI bleeds
Multiple AD lesions
What is the surgical management of AD
Resection and anastomosis of the affected bowel
