Angiodysplasia

ALSO KNOWN AS
Vascular ectasias

DESCRIPTION
* It is theorized that veins in the colon become damaged over time. This causes capillaries to dilate (capillaries are blood vessels that connect the artery side of the circulatory system to the venous side). These dilated capillaries no longer function properly, causing the body to compensate by forming direct connections between the arterial and venous sides-called angiodysplastic lesions. These abnormal blood vessel connections have a tendency to bleed, especially in the elderly.


SYMPTOMS
* Usually occurs after age 70 but can be seen after age 50
* Usually painless
* Bleeding may be in tiny amounts and lead to fatigue, weakness, and shortness of breath secondary to anemia.
* Bright red blood passed from rectum (bleeding may be massive)
* Tarry black stool (melena)
* Vomiting blood or coffee-ground material

CAUSE
* Damaged veins as above
* Congenital (born with these abnormal vessel connections)
* Hereditary hemorrhagic telangiectasia (a rare genetic disease)
* Autoimmune diseases such as Scleroderma

HOW THE DIAGNOIS IS MADE
* Rectal examination positive for blood
* Complete blood count may show anemia
* Colonoscopy (scope passed from rectum to colon)
* Endoscopy (scope passed from throat into stomach)
* Special push enteroscope (scope to view small intestines)
* Nuclear red blood cell scan

TREATMENT
* If slow bleeding over time:

1. Iron supplementation
2. Specific hormone therapy (estrogen-progesterone)

* Rapid or massive bleeding:

1. Cautery (heater probe) or laser treatment
2. Angiography (dye injected and X-Rays taken) to localize bleeding area. Then vasopressin (constricts blood vessel) is injected into the area to stop bleeding, or the area is embolized (an artificial blockage of the angiodysplastic lesion is made).
3. Right hemicolectomy (partial removal of colon) if bleeding is uncontrollable, recurrent, and in right colon
4. Surgical sewing in other areas of uncontrollable or recurrent bleeding

SIMILAR CONDITIONS
* Colorectal Cancer
* Rectal Cancer
* Anus cancer
* Colon Polyps
* Hemorrhoids
* Esophageal Varices
* Ulcer Disease
* Ischemic Colitis