Name = PAGENAME
Caption = An angiodysplasia in the colon being treated with
argon plasma coagulationadministered via probe through the colonoscope. The patient had multiple colonic angiodysplasiae in the setting of aortic stenosis.
DiseasesDB = 2963
ICD10 = ICD10|K|55|2|k|55
ICD9 = ICD9|569.84, ICD9|569.85
eMedicineSubj = med
eMedicineTopic = 134
MeshID = D016888In
medicine( gastroenterology), angiodysplasia is a small vascular malformation of the gut. It is a common cause of otherwise unexplained gastrointestinal bleeding and anemia. Lesions are often multiple, and frequently involve the cecumor ascending colon, although they can occur at other places. Treatment may be with endoscopic interventions, medication, or occasionally surgery.
igns and symptoms
Although some cases present with black, tarry stool (
melena), the blood loss can be subtle, with the anemia symptoms predominating. Fecal occult bloodtesting is positive when bleeding is active. If bleeding is intermittent the test may be negative at times.
Diagnosis of angiodysplasia is often accomplished with
endoscopy, either colonoscopyor esophagogastroduodenoscopy(EGD). Although the lesions can be notoriously hard to find, the patient usually is diagnosed by endoscopy. A new technique, pill enteroscopy, has been a major advance in diagnosis, especially in the small bowelwhich is difficult to reach with traditional endoscopy. With this technique a pill that contains a video camera and radio transmitter is swallowed, and pictures of the small intestine are sent to a receiver worn by the patient.
Angiodysplasiae in the small bowel can also be diagnosed and treated with
double-balloon enteroscopy, a technique involving a long endoscopic camera and overtube, both fitted with balloons, that allow the bowel to be accordioned over the camera.cite journal |author=Neumann H, Mönkemüller K, Malfertheiner P |title=Obscure overt GI bleeding secondary to angiodysplasias at the hepaticojejunostomy diagnosed and successfully treated with double-balloon enteroscopy |journal=Gastrointest Endosc |volume= 67|issue= |pages=563|year=2007 |pmid=17981272 |doi=10.1016/j.gie.2007.06.051]
In cases with negative endoscopic findings and high clinical suspicion, selective
angiographyof the mesenteric arteries is sometimes necessary, but this allows for interventions at time of the procedure. An alternative is scintigraphywith red blood cells labeled with a radioactivemarker; this shows the site of the bleeding on a gamma camerabut tends to be unhelpful unless the bleeding is continuous and significant.cite journal |author=Mitchell SH, Schaefer DC, Dubagunta S |title=A new view of occult and obscure gastrointestinal bleeding |journal=Am Fam Physician |volume=69 |issue=4 |pages=875–81 |year=2004 |pmid=14989574 |url=http://www.aafp.org/afp/20040215/875.html]
Histologically, it resembles
telangiectasia. Development is related to age and strain on the bowel wall, which is thought to influence the caliber change and proliferation of the vascular tissue.cite journal |author=Warkentin TE, Moore JC, Anand SS, Lonn EM, Morgan DG |title=Gastrointestinal bleeding, angiodysplasia, cardiovascular disease, and acquired von Willebrand syndrome |journal=Transfusion medicine reviews |volume=17 |issue=4 |pages=272–86 |year=2003 |pmid=14571395|doi=10.1016/S0887-7963(03)00037-3]
Although angiodysplasia is probably quite common, the risk of
bleedingis increased in disorders of coagulation. A classic association is Heyde's syndrome(coincidence of aortic valve stenosisand bleeding from angiodysplasia). In this disorder, von Willebrand factor(vWF) is proteolysed due to high shear stressin the highly turbulent blood flow around the aortic valve. vWF is most active in vascular beds with high shear stress, including angiodysplasias, and deficiency of vWF increases the bleeding risk from such lesions.
Warkentin "et al" argue that apart from aortic valve stenosis, some other conditions that feature high shear stress might also increase the risk of bleeding from angiodysplasia.
If the anemia is severe,
blood transfusionis required before any other intervention is considered. Endoscopic treatment is an initial possibility, where cautery or argon plasma coagulation(APC) laser treatment is applied through the endoscope. Resectionof the affected part of the bowel may be needed. However, the lesions may be widespread, making such treatment impractical. Embolisationthrough angiographyis occasionally contemplated with severely bleeding lesions that cannot be visualised on colonoscopy.
If the bleeding is from multiple or inaccessible sites, systemic therapy with
medicationmay be necessary. First-line options include the antifibrinolytics tranexamic acidor aminocaproic acid. Estrogens can be used to stop bleeding from angiodysplasia. Estrogens cause mild hypercoaguability of the blood. Estrogen side effects can be dangerous and unpleasant in both sexes. Changes in voice and breast swelling is bothersome in men, but older women often report improvement of libidoand perimenopausal symptoms. (The worries about hormone replacement therapy/HRT, however, apply here as well.)
In difficult cases, there have been positive reports about
octreotide[cite journal |author=Junquera F, Saperas E, Videla S, Feu F, Vilaseca J, Armengol JR, Bordas JM, Piqué JM, Malagelada JR |title=Long-term efficacy of octreotide in the prevention of recurrent bleeding from gastrointestinal angiodysplasia |journal=Am. J. Gastroenterol. |volume=102 |issue=2 |pages=254–60 |year=2007 |pmid=17311647 |doi=10.1111/j.1572-0241.2007.01053.x] and thalidomide, [cite journal |author=Shurafa M, Kamboj G |title=Thalidomide for the treatment of bleeding angiodysplasias |journal=Am. J. Gastroenterol. |volume=98 |issue=1 |pages=221–2 |year=2003 |pmid=12526972 |doi=10.1111/j.1572-0241.2003.07201.x]
In severe cases or cases not responsive to either endoscopic or medical treatment,
surgerymay be necessary to arrest the bleeding.
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Look at other dictionaries:
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