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Angiodysplasia

Refers to a small vascular malformation of the gut.

A common cause of unexplained gastrointestinal bleeding and anemia.

Lesions are often multiple.

Lesions frequently involve the cecum or ascending colon, although they can occur at other places.

Treatment may be with endoscopic interventions, medication, or occasionally surgery.

Blood loss can be subtle and presenting with anemia.

Tarry stools may occur.

Fecal occult blood testing may be positive with active bleeding.

Diagnosis achieved by endoscopy, either colonoscopy or esophagogastroduodenoscopy.. Although the lesions can be notoriously hard to find, the patient usually is diagnosed by endoscopy.

Camera studies, by pill enteroscopy is useful in diagnosing lesions particularly of the small bowel.

In cases with negative endoscopic findings angiography of the mesenteric arteries may be helpful in making a diagnosis, and allows for interventional therapy.

Increases with age.

Risk of bleeding is increased in disorders of coagulation.

Associated with advanced kidney disease.

Heyde’s syndrome, refers to the coincidence of aortic valve stenosis and bleeding from angiodysplasia.

In the Heyde’s syndrome von Willebrand factor (vWF) is proteolysed due to high shear stress in the turbulent blood flow around the aortic valve.

vWF is most active in vascular beds with high shear stress, including angiodysplasias.

Endoscopic treatment with cautery or argon plasma coagulation (APC) may be therapeutic.

Resection of the affected part of the bowel may be required.

Embolization through angiography is occasionally successful.

Systemic therapy with antifibrinolytics tranexamic acid or aminocaproic acid may be helpful.

Estrogens can be used to stop bleeding.

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