Angiodysplasia of the colon

Colorectal

Clinicals - History

Fact Explanation
Asymptomatic Angiodysplasia is also known as the vascular ectasia. Many patients are asymptomatic, and the lesions are found incidentally, such as with screening colonoscopy. Asymptomatic
Angiodysplasia is also known as the vascular ectasia. Many patients are asymptomatic, and the lesions are found incidentally, such as with screening colonoscopy.
Age Commonly presents in the elderly population, usually between 60-69 years of age. There are some cases reported in the young people as well. Age
Commonly presents in the elderly population, usually between 60-69 years of age. There are some cases reported in the young people as well.
Bleeding per rectum Angiodysplasia commonly affects the caecum and ascending colon less commonly located in the jejunum and/or ileum and the remainder are throughout the alimentary tract. It is a significant cause of bleeding in the elderly people. Degenerative pathology with aging is known to be associated. Lesions occur due to the intermittent partial chronic obstruction of the submucosal veins at the points where they penetrate the muscle layers of the colon. Gradual dilatation of these vessels produces arteriovenous communications. Appearance would be flat, red spots (2-5 mm) or slightly raised dilatations, It may cause either acute massive gastrointestinal bleeding or intermittent long term bleeding. Usually it will be altered blood with a maroon-colored stool.Malena and haematamesis is occasionally disease can be found in the duodenum and upper GI tract causing upper GI bleeding. Bleeding per rectum
Angiodysplasia commonly affects the caecum and ascending colon less commonly located in the jejunum and/or ileum and the remainder are throughout the alimentary tract. It is a significant cause of bleeding in the elderly people. Degenerative pathology with aging is known to be associated. Lesions occur due to the intermittent partial chronic obstruction of the submucosal veins at the points where they penetrate the muscle layers of the colon. Gradual dilatation of these vessels produces arteriovenous communications. Appearance would be flat, red spots (2-5 mm) or slightly raised dilatations, It may cause either acute massive gastrointestinal bleeding or intermittent long term bleeding. Usually it will be altered blood with a maroon-colored stool.Malena and haematamesis is occasionally disease can be found in the duodenum and upper GI tract causing upper GI bleeding.
Dysentry and intermittent abdominal pain This may present as recurrent episodes, which might be mistaken for the infectious dysentry. Dysentry and intermittent abdominal pain
This may present as recurrent episodes, which might be mistaken for the infectious dysentry.
Symptos of anaemia : Shortness of breath on exertion, lethargy Intermittent chronic blood loss may cause anaemia. Low oxygen to the tissues due to the anaemia, causes lack of energy. Symptos of anaemia : Shortness of breath on exertion, lethargy
Intermittent chronic blood loss may cause anaemia. Low oxygen to the tissues due to the anaemia, causes lack of energy.
History of valvular heart disease There can be nonoclusive mesenteric ischemiadue to the peripheral vasoconstriction and redistribution of sphanchnic blod flow associated with low cardiac output in this disorder. History of valvular heart disease
There can be nonoclusive mesenteric ischemiadue to the peripheral vasoconstriction and redistribution of sphanchnic blod flow associated with low cardiac output in this disorder.

Clinicals - Examination

Fact Explanation
Pallor Anaemia due to intermittent chronic blood loss. Pallor
Anaemia due to intermittent chronic blood loss.
Low blood pressure and tachycardia Sometimes bleeding may be massive; causing hypotension and shock. Low blood pressure and tachycardia
Sometimes bleeding may be massive; causing hypotension and shock.
Ejection systolic murmer at aortic area radiating to the neck Some studies have shown that there is increased incidence of aortic stenosis among the patients with angiodysplasia and other vascular malformations. Ejection systolic murmer at aortic area radiating to the neck
Some studies have shown that there is increased incidence of aortic stenosis among the patients with angiodysplasia and other vascular malformations.

Investigations - Diagnosis

Fact Explanation
Angiography Clusters of small arteries during the arterial phase at the antimesenteric border, accumulation of vascular spaces and opacification of the bowel during the capillary phase, early opacification of the veins draining the caecum and ascending colon are the features for the diagnosis on angiography. Superior mesenteric arteriography is done using 50-
60 ml of meglumine diatrizoate injected at 5-6 mI/sec and is followed by
serial radiographs.
Angiography
Clusters of small arteries during the arterial phase at the antimesenteric border, accumulation of vascular spaces and opacification of the bowel during the capillary phase, early opacification of the veins draining the caecum and ascending colon are the features for the diagnosis on angiography. Superior mesenteric arteriography is done using 50-
60 ml of meglumine diatrizoate injected at 5-6 mI/sec and is followed by
serial radiographs.
Colonoscopy/sigmoidoscopy Colonoscopy is more sensitive and accurate than sigmoidoscopy in diagnosing angiodysplasia.These may be operator dependent. Active bleeding will limit the use of the investigation. It is also important as to exclude the other lesions in the colon before the hemicolectomy. Colonoscopy/sigmoidoscopy
Colonoscopy is more sensitive and accurate than sigmoidoscopy in diagnosing angiodysplasia.These may be operator dependent. Active bleeding will limit the use of the investigation. It is also important as to exclude the other lesions in the colon before the hemicolectomy.
Barium meal and follow through As it is difficult to detect them by barium studies as the lesions are small and focal in distribution. Barium meal and follow through
As it is difficult to detect them by barium studies as the lesions are small and focal in distribution.
Stool occult blood test Stool for occult blood is positive even in asymptomatic people. Stool occult blood test
Stool for occult blood is positive even in asymptomatic people.

Investigations - Management

Fact Explanation
Full blood count Chronic intermittent bleeding can cause iron deficiency anaemia, which will manifest as low haemoglobin. Full blood count
Chronic intermittent bleeding can cause iron deficiency anaemia, which will manifest as low haemoglobin.
Full blood count Chronic intermittent bleeding can cause iron deficiency anaemia , which will manifest as low haemoglobin, reduced mean corpuscular volume and mean corpuscular haemoglobin with microcytic anaemia and increased red cell distribution width. Full blood count
Chronic intermittent bleeding can cause iron deficiency anaemia , which will manifest as low haemoglobin, reduced mean corpuscular volume and mean corpuscular haemoglobin with microcytic anaemia and increased red cell distribution width.
99 Tc scintigraphy This is commonly used as a screening tool. There is a possibility of detecting very low rates of blood loss by this method using 99 Tc sulfur colloid or 99 Tc labelled red blood cells. 99 Tc scintigraphy
This is commonly used as a screening tool. There is a possibility of detecting very low rates of blood loss by this method using 99 Tc sulfur colloid or 99 Tc labelled red blood cells.
Echocardiogram Some patients have the underlying cardiac disorders that can cause low perfusion and ischaemia of the walls of intestines. Echocardiogram
Some patients have the underlying cardiac disorders that can cause low perfusion and ischaemia of the walls of intestines.

Management - Supportive

Fact Explanation
Resuscitation Patients can present with acute massive gastrointestinal haemorrhage needing resuscitation. Special attention should be focused on circulation due to the massive blood loss. Volume resuscitation may be needed. Resuscitation
Patients can present with acute massive gastrointestinal haemorrhage needing resuscitation. Special attention should be focused on circulation due to the massive blood loss. Volume resuscitation may be needed.
Embolization Angiodysplasia with acute hemorrhage can be treated with embolization to control the bleeding. It is better than selective infusion of vasopressin as it causes less bleeding rate. Embolization
Angiodysplasia with acute hemorrhage can be treated with embolization to control the bleeding. It is better than selective infusion of vasopressin as it causes less bleeding rate.
Vasopressin and octreotide Intra-arterial vasopressin is used to control massive lower gastrointestinal bleeding. Octreotide treatment will be useful in patients with refractory gastrointestinal bleeding especially in those need anticoagulant treatment. Vasopressin and octreotide
Intra-arterial vasopressin is used to control massive lower gastrointestinal bleeding. Octreotide treatment will be useful in patients with refractory gastrointestinal bleeding especially in those need anticoagulant treatment.
Management of anaemia Anaemia can be due to chronic intermittent blood loss, If significant anaemia present with clinical features they need to get treatment and if needed even blood transfusion. Management of anaemia
Anaemia can be due to chronic intermittent blood loss, If significant anaemia present with clinical features they need to get treatment and if needed even blood transfusion.
Pre op angiography Selective angiography is recommended for the preoperative localization of bleeding sites. Pre op angiography
Selective angiography is recommended for the preoperative localization of bleeding sites.

Management - Specific

Fact Explanation
Conservative approach Conservative approach is suitable for the hemodynamically stable patients as bleeding can stop spontaneously in the majority of patients. Blood transfusion, management of anaemia are important. Conservative approach
Conservative approach is suitable for the hemodynamically stable patients as bleeding can stop spontaneously in the majority of patients. Blood transfusion, management of anaemia are important.
Surgery Surgery is the management option with highest cure rate. It is done when the endoscopic ablation is not suitable or if life-threatening hemorrhage occurs. Right hemicolectomy or if relevant total colectomy is done. Histological examination will show angiodysplastic lesions in different parts of the colon. Surgery
Surgery is the management option with highest cure rate. It is done when the endoscopic ablation is not suitable or if life-threatening hemorrhage occurs. Right hemicolectomy or if relevant total colectomy is done. Histological examination will show angiodysplastic lesions in different parts of the colon.
Endoscopic obliteration techniques Gastric and duodenal angiodysplastic lesions are treated in this way, endoscopic laser photocoagulation is a method used for the colonic angiodysplasia. Endoscopic band ligation is also done. Endoscopic obliteration techniques
Gastric and duodenal angiodysplastic lesions are treated in this way, endoscopic laser photocoagulation is a method used for the colonic angiodysplasia. Endoscopic band ligation is also done.

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