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🌱 來自: lower gastrointestinal bleeding

vascular etiology of lower gastrointestinal bleeding

Angioectasia AVMs, HHT (see below)

AVMs congenital. Angioectasia (ectatic submucosal vessels) a/w ↑ age, CKD, cirrhosis, CTD, severe CV dis. Heyde syndrome: GIB due to angioectasias + aortic stenosis. Rx: endoscopic Rx.

Dieulafoy’s lesion

Large (1–3 mm) submucosal artery protruding through fundal mucosa → sudden, massive UGIB. Difficult to identify. Endo Rx.

Gastric antral vascular ectasia (GAVE)

• “Watermelon stomach”; ectatic gastric vessels, often a/w cirrhosis, CTD, typically older ♂.
• Rx w/ EGD w/ thermal hemostasis, repeat q4–8wk to eradicate lesions. TIPS does not improve outcomes.

Aortoenteric fistula

AAA or aortic graft erodes into 3rd portion of duodenum. P/w “herald bleed.” If low suspicion → endoscopy; if high → CT angiography.