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Angiodysplasia (Differentials (Autoimmune IBD, Trauma Anal fissure,…
Angiodysplasia
Differentials
Autoimmune
IBD
Trauma
Anal fissure
Iatrogenic
Recent colonoscopy/surgery
Infection
Gastroneteritis, proctitis
Neoplastic
Anal/colon cancer
Vascular
Haemorrhoids
Mesenteric ischemia
Degenerative
Diverticular disease
Diagnosis
Examination
Abdo - often nil
PR - malaena, fresh blood
Investigations
Bedside
Obs - shock if big bleed
Bloods
FBC (anaemia if chronic), CRP/ESR, U+E,
LFTs, clotting, group&save/crossmatch
Imaging
Colonoscopy (diagnostic)
Mesenteric angiography
History
PC/HPC: PR bleed, malaena, no pain
PMH: prev bleeds, cancers, IBD, diverticular
DH: NSAIDs, steroids, anticoagulants, allergies
FH: cancer, IBD, other GI pathology
SH: smoking, alcohol, diet
Pathophysiology
Cause unclear
AVMs present in the submucosa, usually colonic
but can be small bowel or elsewhere in the GIT
Clinical
presentation
PR bleed
Melaena
Management
Initial ABCDE
Definitive
Conservative
Surgical referral
NBM until surgical r/v
Medical
IV fluids
Fluids or blood products
if large bleed
Analgesia
If associated pain
Surgical
Mesenteric angio with embolisation
Endoscopic laser coagulation
Colonic resection
Epidemiology
Elderly
Definition
Gastrointestinal disorder of AVMs
in the bowel causing PR bleeds