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Updated: Jul 22 2017

Angiodysplasia

Introduction
  • Most common vascular abnormality of the GI tract  
  • Second leading cause of lower GI bleeding in patients older than 60 years
    • diverticulosis is #1
    • most common cause of lower GI bleeding in patients with chronic renal failure or end-stage renal disease
  • A degenerative lesion of previously healthy blood vessels
    • 77% of angiodysplasias are located in the cecum and ascending colon
    • 15% are located in the jejunum and ileum
    • associated with aortic stenosis
Presentation
  • Symptoms
    • hematochezia (60%)
    • melena (26%)
    • hematemesis frequently is observed in patients with angiodysplasia of the upper GI tract
  • Physical exam
    • hemocult positive stool (47%)
Evaluation
  • Colonoscopy or angiography
  • Capsule endoscopy
    • used to assess small intestine
  • Microcytic hypochromic anemia
    • iron deficiency anemia (51%)
    • reflecting iron deficiency
    • observed in 10-15% of cases
Treatment
  • A conservative approach to patients who are hemodynamically stable is recommended
    • most bleeding angiodysplasias will cease spontaneously
    • cautery of the AVM can be done in refractory cases 
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