Angiodysplasia

Question 1

What is angiodysplasia?

Answer 1

• Most common vascular abnormality in GI tract
• Formation of arteriovenous malformations between previously healthy blood vessels
• Most common in caecum and ascending colon (when GI)

Question 2

Pathophys of angiodysplasia

Answer 2

• Congential - heriditary haemorrhagic telangiectasia (Rendu-Osler-Weber syndrome)
• Acquired

Question 3

How does acquired angiodysplasia occur?

Answer 3

• Reduced submucosal venous drainage from colon
• This is from chronic and intermittent contraction of the colon –> dilated and tortuous veins
• This then causes loss of pre-capillary sphincter competency allowing formation of small arterio venous malformations

PS - smooth muscle that help direct bloodflow into capillaries

Question 4

What do both congential and acquired cases of angiodysplasia result in?

Answer 4

Formation of small tufts of dilated vessels which are prone to haemorrhage

Question 5

Symptoms of angiodysplasia

Answer 5

• Occult PR bleeding - identified via screening or new onset anaemia
• 10-15% - acute haemorrhage with haematochezia, melena, haematemesis

Question 6

Examination findings for angiodysplasia

Answer 6

• None
• If chronic may be signs of anaemia

Question 7

Bedside and bloods inv for angiodysplasia

Answer 7

• FBC
• Clotting profile
• Group and save
• Crossmatch if needs blood

Question 8

Imaging for angiodysplasia

Answer 8

• CT angiogram if large bleeds - find location of bleed
• If possible can do IR guided embolisation to control bleeding
• If stable - endoscopy either OGD if upper or proximal duodenum, colonoscopy if colonic/terminal ileium or capsule endoscopy if small bowel

Interventional radiology

Question 9

Management angiodysplasia

Answer 9

• Via endoscopic imaging using argon plasma coagulation
• Bleeding vessel is subjected to electrical current and argon stopping the bleeding
• Other options inc monopolar electrocautery, laser photoablation, sclerotherapy and band ligation - all less common

Question 10

Management of angiodysplasia not accessible via endoscopy or refractory to treatment

Answer 10

• Mesenteric angiography with super-selective cathterisation and embolisation

Question 11

When is surgery done for angiodysplasia?

Answer 11

• Acute large refractory bleeding
• Multiple angiodysplastic lesions - angiography and endoscopic management failed

Question 12

Surgical procedures for angiodysplasia

Answer 12

• Depends on location
• Operation involves resection of that region
• eg gastric or bowel resection +/- primary anastomosis

Question 13

Complications associated with angiodysplasia

Answer 13

• Re-bleeding post therapy
• Endoscopy - bowel perforation
• Mesenteric angiography - haematoma formation, arterial dissection and bowel ischaemia