home
about the project
Medical news
For authors
Licensed books on medicine
<< Previous Next >>

Vascular ectasia as an example of chronic bleeding from the gastrointestinal tract

Vascular ectasia, or angio dysplasia, is one of the common causes of both profuse and minor prolonged bleeding from the lower parts of the gastrointestinal tract. Most of them are associated with age-related degenerative changes in the vascular wall in the elderly. In other age groups, vascular wall disorders can be congenital. Two-thirds of patients with small intestinal angio dysplasia are older than 70 years. Angio-dysplastic lesions are usually multiple, less than 5 mm in diameter and localized in the cecum and in the right part of the transverse colon (Fig. 9-6). There is some correlation with aortic stenosis. The diagnosis of vascular ectasia is made according to the results of colonoscopy and angiography (ectasia is detected even in the absence of bleeding). Thus, the presence of angiodysplasia in patients with repeated bleeding in the absence of other sources of blood loss is the basis for initiating therapy.

The pathogenesis of angiodysplasia is not fully understood. There is a theory that angio-dysplastic changes are associated with periodic obstruction of the veins of the submucosal layer of the intestine at the points of passage through the muscle fibers, which leads to their expansion and change in the vascular wall. Sometimes dilatation of the entire arterio-capillary-venous complex may occur with impaired arteriovenosis

Fig. 9-6.

Typical angio-dyslastic changes in the colon mucosa





no circulation.
The predominant localization of angio-dysplastic changes in the cecum and the right part of the ileum is associated with a higher intraluminal pressure in this part of the intestine.

In approximately 5% of patients, despite an intensive examination (radiological, endoscopic, angiographic), it is not possible to identify the source of bleeding. The source of blood loss in such patients, apparently, are vascular ectasia. Unfortunately, most of these changes are so small that they cannot be detected by angiographic and endoscopic examinations.

If angio-dysplastic changes are detected, it is advisable to carry out their cauterization under endoscopic control. In the case of multiple bowel lesions, or the impossibility of endoscopic ablation (cauterization), a resection of the affected intestine is performed. With a combination of vascular ectasia with chronic renal failure and with a corresponding increase in bleeding time due to platelet dysfunction, it is advisable to carry out estrogen progesterone therapy. This therapy is also effective in the absence of manifestations of renal failure. Treatment with a combination of estrogen and progesterone can be carried out for patients with angio dysplasia even in the absence of a definitive diagnosis. In case of impossibility of surgical treatment of bleeding (localization, severe concomitant pathology not found), supportive blood transfusions are carried out.
<< Previous Next >>
= Skip to textbook content =

Vascular ectasia as an example of chronic bleeding from the gastrointestinal tract

  1. Bleeding in gastric ulcer as an example of bleeding from the upper gastrointestinal tract
    Gastric and duodenal ulcers cause about 50.% of cases of bleeding from the upper gastrointestinal tract (Table 9-2). Despite the introduction of new effective methods of treating peptic ulcer in the past 15 years, the frequency of bleeding with this pathology has not practically decreased. One of the reasons for this situation is the fact that often peptic ulcer
  2. Acute and chronic bleeding from the gastrointestinal tract
    There are many causes of gastrointestinal bleeding. Bleeding develops according to one of two primary mechanisms: 1. Violation of the integrity of the mucous membrane, leading to exposure of deep vessels, their erosion. For example, bleeding from a stomach ulcer, bleeding from the intestines during infectious or idiopathic processes, from the small and large intestines during ischemia. 2.
  3. Gastrointestinal bleeding
    Gastrointestinal bleeding is a problem that doctors in the USA often encounter (300 thousand hospitalizations annually). The degree of hemorrhage varies from small slow bleeding to life-threatening conditions that contribute to the development of iron deficiency anemia. Mortality from upper gastrointestinal tract in the USA is 8%. This indicator has not changed much.
  4. Bleeding from the upper gastrointestinal tract
    It is customary to talk about bleeding from the upper gastrointestinal tract (GIT) in cases where the source of bleeding is located either in the esophagus, or in the stomach, or in the duodenum (duodenum). Pathophysiology The most common causes of bleeding in adults are: duodenal ulcer; erosion of the stomach and duodenum; varicose veins
  5. Prognosis for bleeding from the upper gastrointestinal tract
    There are several criteria for poor prognosis for bleeding from the upper gastrointestinal tract. The most important is the cause of the bleeding. So, for bleeding from varicose veins, the highest frequency of repeated bleeding (relapses) and deaths is characteristic. In primary hospitalization, mortality in this type of bleeding is 30%, with repeated - 50-70%.
  6. The principles of treatment of bleeding from the gastrointestinal tract with portal hypertension
    Bleeding from varicose nodes is the most abundant of all types of bleeding that occurs in the upper parts of the gastrointestinal tract, in which the patient requires emergency medical care. In more than 90% of cases of such bleeding, the hematocrit level drops sharply and becomes less than 30% of normal, resulting in the need for
  7. Etiology of bleeding from the lower gastrointestinal tract
    Lesions in the anal region and rectum. Small amounts of bright red blood on the surface of feces and toilet paper often appear with hemorrhoids; bleeding in this case is usually aggravated by the difficult passage of solid feces. Similarly, fissures and fistulas in the anal region can occur. Another source of rectal bleeding is proctitis; he
  8. Diagnosis of bleeding from the gastrointestinal tract
    Diagnosis of gastrointestinal bleeding
  9. Gastrointestinal Lymphoma
    In systemic dissemination of non-Hodgkin lymphoma (see chapter 13), any segment of the gastrointestinal tract may be involved again. However, up to 40% of lymphomas develop not in the lymph nodes, but in other organs, among which the intestine is the most frequent localization. By the time of recognition of the primary lymphoma of the gastrointestinal tract, the tumor process does not affect either the liver or
  10. Gastrointestinal metabolism
    Liquid and electrolytes are excreted in large quantities with digestive secretions in the gastrointestinal tract, but under normal conditions they are mostly reabsorbed (Fig. 20). Fig. 20. Secretion of water and electrolyte (meq / l of the amount of secretion indicated in the table) (Geigy). Potassium is excreted in the intestines (especially in the large intestine), and it is replaced during the exchange process with sodium (Gooptu with
  11. Gastrointestinal Tumors
    In the organs of the gastrointestinal tract (hollow organs, pancreas, liver, biliary tree), various types of tumors are much more common than in other systems of the body, and such patients have a much higher degree of probability of death. However, there is no single simple explanation for the etiology of tumors of the gastrointestinal tract. International studies
  12. Gastrointestinal tract
    More than half of pregnant women have an increase in appetite, weight gain can reach 400 g per week, and by the end of pregnancy is 12 kg. Such a change in the regulation of feelings of hunger and satiety provides increased needs of the mother's body for energy and plastic materials. Often there are taste perversions and whims associated with a change in the secretory function of the gastrointestinal tract.
  13. Gastrointestinal diseases
    Conditions leading to dysphagia Causes: • tumor esophageal stricture; • ???? achalasia; • ???? diffuse spasm of the esophagus; • ???? medicinal esophagitis; • ???? hiatal hernia; • ???? collagenoses; • ???? chemical burn of the esophagus; • ???? diverticulum of the esophagus; • ???? esophageal infections (candidiasis). Features of anesthesia: • preoperative preparation is needed
Medical portal "MedguideBook" © 2014-2019
info@medicine-guidebook.com