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Small Intestinal Angiodysplasia


Presentation

  • Risk factors associated with poor outcome include advancing age, liver disease, patient presenting in hypovolaemic shock, and current inpatients (who have almost 4 times associated mortality compared to an outpatient at presentation).[teachmesurgery.com]
  • Small arteriovenous communications are also present and are due to incompetence of the precapillary sphincter.[gastrointestinalatlas.com]
  • Patients often present with heme-positive stools or modest amounts of bright red blood from the rectum. Bleeding is often intermittent, sometimes with long periods between episodes. Patients with upper GI lesions may present with melena.[msdmanuals.com]
  • Physicians should thus decide which test to use based on individual clinical presentation, Dr. Leighton advised.[acphospitalist.org]
  • Approximately 10% of patients with angiodysplasia present with iron deficiency anemia, and, thus, a complete blood cell (CBC) count and serum iron levels would be useful.[clinicaladvisor.com]
Melena
  • Case 4 A 40-year-old female, who had been on chronic hemodialysis for six years for undetermined nephropathy, developed GI hemorrhage with melena.[sjkdt.org]
  • Black, tarry stools ( melena ) and occasional episodes of bright red blood rectal bleeding ( hematochezia ) may be the only obvious signs of angiodysplasia.[healthhype.com]
  • Overt bleeding consisted of hematemesis in 3 cases, melena in 34 cases and hematochezia in 18 cases.The sites involved in angiodysplastic lesions were: gastric in 18 cases (26%), small bowel 14 (20%), colon 53 (77%), including predominantly the right[latunisiemedicale.com]
  • Patients with upper GI lesions may present with melena. Major bleeding is unusual. Vascular lesions are most commonly diagnosed endoscopically.[msdmanuals.com]
  • Signs and symptoms [ edit ] Although some cases present with black, tarry stool ( melena ), the blood loss can be subtle, with the anemia symptoms predominating. Fecal occult blood testing is positive when bleeding is active.[en.wikipedia.org]
Intestinal Disease
  • diseases Your colon, also known as the large intestine, is part of your digestive system.[icdlist.com]
  • disease” OR “gastrointestinal tract”) AND (“angiography” OR “argon plasma coagulation” OR “gastrointestinal endoscopy” OR “intestine endoscopy” OR “double balloon enteroscopy” OR “single balloon enteroscopy” OR “spiral enteroscopy” OR “Gastrointestinal[nature.com]
Acute Abdomen
  • Srpski Arhiv za Celokupno Lekarstvo. 2012; 140(3-4): 168-172 [Pubmed] 3 Angiodysplasia (vascular malformations) of the colon presenting as an acute abdomen Yannam, G.R. and Yu, D.C. and Kelly, D.R. and Chen, M.K. and Beierle, E.A.[sjkdt.org]
  • Angiodysplasia (vascular malformations) of the colon presenting as an acute abdomen. J Pediatr Surg. 2012 Oct. 47(10):e37-40. [Medline]. Richter JM, Hedberg SE, Athanasoulis CA, Schapiro RH. Angiodysplasia.[emedicine.medscape.com]
Maroon Stools
  • Because of the inability to localize a bleeding site in the small bowel, patients with obscure GI bleeding from a small bowel source typically presented with prolonged occult blood loss or recurrent episodes of melena or maroon stool without a specific[clinicalgate.com]
Vascular Disease
  • You are more likely to have vascular disease as you get older.[icdlist.com]
  • Vascular diseases of the gastrointestinal tract. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 143. Updated by: Michael M.[medlineplus.gov]
  • Vascular diseases of the gastrointestinal tract. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 143. Reviewed By: Michael M.[ufhealth.org]
  • Vascular diseases of the gastrointestinal tract. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 143. Version Info Last reviewed on: 9/29/2017 Reviewed by: Michael M.[mountsinai.org]
  • The cause of AD is still unknown, and it could be related to vascular degenerative process accelerated by hypoxygenation of the intestinal mucosa secondary to atherosclerotic peripheral vascular disease. [6], [7], [8] Microscopically AD consists of dilated[sjkdt.org]
Fracture
  • Pathologic fracture is seen. In one third of patients, MM is diagnosed after a pathologic fracture occurs; as it did happens in our patient, such fractures commonly involve the axial skeleton. Video Endoscopic Sequence 20 of 24.[gastrointestinalatlas.com]

Workup

  • In general, surgery for obscure GI bleeding is indicated for patients who continue to bleed and have had negative endoscopic and radiologic workups, and who are clearly operative candidates.[acphospitalist.org]
  • During workup, packed red blood cells (RBCs) were transfused. The level of hemoglobin increased to 9.3 g/dL and remained stable. Dyspnea was relieved, with stable vital signs. He was discharged with the instruction to take aspirin only.[e-ce.org]
  • Nevertheless, a second endoscopy study is advisable in patients with OGIB with a suboptimal first endoscopic workup.[scielo.isciii.es]

Treatment

  • Significant updates on bariatric surgery, Barrett's esophagus, endoscopic ultrasound, endosonography, treatment of liver disease, and much more keep you current on the latest advances.[books.google.com]
  • The cauterized group (follow-up, 30 /- 18 months) significantly improved, requiring 2.40 /- 2.97 units/month before treatment and 0.32 /- 0.91 units/month after cauterization (p 0.0001, paired t test).[ncbi.nlm.nih.gov]
  • Unlike others on this topic, this text demonstrates how the endoscope incorporates pathophysiology, diagnostic, and treatment modalities into endoscopic practice.[books.google.de]

Prognosis

  • (Outcomes/Resolutions) The prognosis of Gastrointestinal Angiodysplasia is generally excellent with adequate and appropriate treatment.[dovemed.com]
  • […] areas ( 5 mm) of contrast enhancement in the bowel wall (most prominent in the enteric phase 3 ) early filling of an antimesenteric vein 4 Angiography ectatic vessels but no mass 6 early venous enhancement indicating arteriovenous shunting Treatment and prognosis[radiopaedia.org]
  • Outlook (Prognosis) People who have bleeding related to this condition despite having had colonoscopy, angiography, or surgery are likely to have more bleeding in the future. The outlook remains good if the bleeding is controlled.[ufhealth.org]
  • Among the treatment modalities, surgery can be considered when endoscopic or angiographic treatment is not suitable, or when the patient has poor prognosis factors. Fig. 1.[e-ce.org]

Etiology

  • The condition occurs mainly in older women and is of unknown etiology.[msdmanuals.com]
  • Angiodysplasia (AD) of the small bowel is the most frequent etiology of otherwise unexplained gastrointestinal bleeding and chronic anemia after negative endoscopic screening, as usually demonstrated by wireless capsule endoscopy (WCE).[em-consulte.com]
  • In this case the exact etiology remained uncertain even after extensive investigations. Most of the common causes of malena in children were ruled out by pre-operative investigations and intra-operative examination.[tropicalgastro.com]
  • Intermittent submucosal venous obstruction, intermittent arterial flow, and local vascular degeneration with local hypoxemia may be potential etiologic factors [ 10, 15, 16 ].[kjim.org]
  • (Etiology) The exact cause of Gastrointestinal Angiodysplasia is unknown.[dovemed.com]

Epidemiology

  • Epidemiological investigation of the prevalence of von Willebrand's disease . Blood 1987; 69 :454–459. 49. Chey WD , Hasler WL , Bockenstedt PL . Angiodysplasia and von Willebrand's disease type IIB treated with estrogen/progesterone therapy .[nature.com]
  • Epidemiology of hospitalization for acute upper gastrointestinal hemorrhage: a population-based study. Am J Gastroenterol. 1995;90:206–10. 20. Longstreth GF, Feitelberg SP.[aafp.org]
  • […] endoscopic modality in the treatment of GAVE and radiation proctitis. [28] GAVE is often associated with systemic illnesses, such as cirrhosis of the liver, autoimmune connective tissue disorders, bone marrow transplantation, and chronic renal failure. [29] Epidemiology[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • Lower Digestive Tract, 2nd Edition, part 2 in the 3-book Digestive System volume, covers the small bowel and colon, and provides a concise and highly visual approach from normal anatomy and physiology through pathophysiology, diagnostics and treatment[books.google.de]
  • Unlike others on this topic, this text demonstrates how the endoscope incorporates pathophysiology, diagnostic, and treatment modalities into endoscopic practice.[books.google.com]
  • The second consideration is the pathophysiology of bleeding lesions in the small intestine.[barnardhealth.us]
  • Vascular ectasias also occur in association with a number of systemic diseases (eg, renal failure, cirrhosis, CREST syndrome [calcinosis cutis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, telangiectasias]—see Pathophysiology ) and after[msdmanuals.com]

Prevention

  • Special chapters, such as the Designing Clinical Research in Gastrointestinal Endoscopy, The Prevention of Infection Following Gastrointestinal Endoscopy, Complications of Peptic Ulcer Disease, and Credentialing for Gastrointestinal Endoscopy, help make[books.google.com]
  • Prevention There are no current guidelines to prevent angiodysplasia of the colon.[cancercarewny.com]
  • Prevention There is no known prevention. Images References Brandt LJ, Aroniadis OC. Vascular disorders of the gastrointestinal tract. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. 10th ed.[ufhealth.org]

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