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Gastric antral vascular ectasia (GAVE) (Pathophysiology (Vascular lesion…
Gastric antral vascular
ectasia (GAVE)
Definition
Vascular lesion of the gastric antrum,
torturous dilated vessels from the pylorus
Epidemiology
Middle aged/elderly women
Pathophysiology
Vascular lesion of dilated, torturous vessels
in the gastric antrum radiating from the pylorus
Can bleed causing acute upper GI bleed
Can cause portal hypertension in some patients
Thrombosis of capillaries, dilated submucosal veins,
hyperplasia of muscularis mucosa
Risk factors
Female
Autoimmune disease e.g. Sjorgrens
Clinical
presentation
Anaemia
Haematemesis
Malaena
Diagnosis
Examination
Abdo: anaemia, otherwise nil
PR: may have malaena
Investigations
Bedside
Obs, ECG
Bloods
FBC (anaemia), Fe studies (Fe deficient),
CRP, U+Es, LFTs, clotting, group&save
Imaging
Endoscopy (diagnosis - watermelon stomoch)
History
HPC: haematemesis, malaena
PMH: autoimmune disease, gastritis
DH: reg meds, allergies
FH: GAVE, gastric ca, ulcers
SH: smoking, alcohol, diet
Management
Initial ABCDE
Definitive
Medical
Fe supplements
Indication: Fe deficiency anaemia
e.g. ferrous sulphate PO
Blood transfusion
Indication: Hb<80
E.g. packed red cells, FFP, Plts
Surgical
Photocoagulation
Indication: active bleeding
E.g. argon plasma, laser
Heater probe therapy