Lower gastrointestinal bleeding pathophysiology: Difference between revisions

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* Numerous visible flask like protrusions along the [[intestinal wall]].
* Numerous visible flask like protrusions along the [[intestinal wall]].
* Thick and corrugated circular muscle fibers with mucosal folds.
* Thick and corrugated circular [[muscle fibers]] with mucosal folds.
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* Numerous [[Inflammatory cells|cells of inflammation]]  
* Numerous [[Inflammatory cells|cells of inflammation]]  
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|Angiodysplasia<ref name="pmid4029903">{{cite journal |vauthors=Stamm B, Heer M, Bühler H, Ammann R |title=Mucosal biopsy of vascular ectasia (angiodysplasia) of the large bowel detected during routine colonoscopic examination |journal=Histopathology |volume=9 |issue=6 |pages=639–46 |year=1985 |pmid=4029903 |doi= |url=}}</ref>
|Angiodysplasia<ref name="pmid4029903">{{cite journal |vauthors=Stamm B, Heer M, Bühler H, Ammann R |title=Mucosal biopsy of vascular ectasia (angiodysplasia) of the large bowel detected during routine colonoscopic examination |journal=Histopathology |volume=9 |issue=6 |pages=639–46 |year=1985 |pmid=4029903 |doi= |url=}}</ref>
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* Tortuous dilation of multiple small submucosal and mucosal blood vessels.
* Tortuous dilatation of multiple small [[submucosal]] and [[mucosal]] blood vessels.
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* Clusters of numerous dilated and thin-walled vessels in [[mucosa]] and [[Submucosal|submucosa]].
* Clusters of numerous dilated and thin-walled [[vessels]] in [[mucosa]] and [[Submucosal|submucosa]].
* Erosion of surrounding mucosa.
* Erosion of surrounding [[mucosa]]
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|Hemorrhoids<ref name="pmid22563187">{{cite journal |vauthors=Lohsiriwat V |title=Hemorrhoids: from basic pathophysiology to clinical management |journal=World J. Gastroenterol. |volume=18 |issue=17 |pages=2009–17 |year=2012 |pmid=22563187 |pmc=3342598 |doi=10.3748/wjg.v18.i17.2009 |url=}}</ref>
|Hemorrhoids<ref name="pmid22563187">{{cite journal |vauthors=Lohsiriwat V |title=Hemorrhoids: from basic pathophysiology to clinical management |journal=World J. Gastroenterol. |volume=18 |issue=17 |pages=2009–17 |year=2012 |pmid=22563187 |pmc=3342598 |doi=10.3748/wjg.v18.i17.2009 |url=}}</ref>
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* Tortuous superficial dilations of multiple blood vessels.
* Tortuous superficial dilatations of multiple blood vessels.
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* Dilated, thick-walled, congested submucosal vessels  
* Dilated, thick-walled, congested submucosal vessels  

Revision as of 18:17, 21 December 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

Superior mesenteric artery and inferior mesenteric artery are the two major blood vessels that supply lower gastrointestinal tract. Disruption of blood vessel junction, formed by these two vessels, by any of the disease process results in bleeding. Diverticulosis is the most common etiology of lower GI bleeding accounting for 30% of all cases, followed by ano-rectal disease, ischemia of bowel, inflammatory bowel disease (IBD), neoplasia, and arteriovenous (AV) malformations. The characteristic gross and microscopic findings of lower gastrointestinal tracts depends upon the underlying pathology.

Pathophysiology

Blood supply

Lower GI Tract Arterial Supply Venous Drainage
Midgut
Hindgut
ɸ -Except lower rectum, which drains into the systemic circulation.
Blood supply to the intestines includes the celiac artery, superior mesenteric artery (SMA), inferior mesenteric artery (IMA), and branches of the internal iliac artery (IIA).
Source: By Anpol42 (Own work) [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)], via Wikimedia Commons

Pathogenesis

The pathogenesis of lower gastrointestinal bleeding can be discussed based on the etiology. Diverticulosis is the most common etiology of lower GI bleeding accounting for 30% of all cases, followed by anorectal disease, ischemia, inflammatory bowel disease (IBD), neoplasia, and arteriovenous (AV) malformations.

Diagram of sigmoid diverticulum
Source:By Anpol42 (Own work) [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)], via Wikimedia Commons
  • Anorectal disease
  • Neoplasia
  • AV Malformation/Angiodysplasia

Associated Conditions

Other diseases that are commonly associated with lower gastrointestinal bleeding include:

Gross and Microscopic Pathology

Disease Gross Pathology Microscopic Pathology
Diverticulosis[37]
Angiodysplasia[38]
Hemorrhoids[8]
  • Tortuous superficial dilatations of multiple blood vessels.
  • Dilated, thick-walled, congested submucosal vessels
  • Papillary endothelial hyperplasia
  • Superficial ulcerations
  • Pagetoid dyskeratosis
Mesenteric ischemia [39]
  • Hemorrhagic infarctions
  • Hemorrhage in lamina propria
  • Necrosis of superficial epithelial
  • Deep crypts
  • Fibrosis
Ischemic colitis[39]
  • Discrete or serpiginous ulcerations
  • Pseudopolyps
  • Hemorrhagic infractions
  • Frank blood or dark mucus in lumen
  • Strictures
Crohn's disease[40][41] 
  • Superficial or deep ulcerations
  • Granulation tissue extending into surrounding submucosa and smooth muscle fibers.
  • Transmural inflammation with lymphoid aggregates
  • Goblet cells
  • Focal neutrophils in epithelium
  • Lymphoid aggregates
  • Plasmacytosis
  • Edematous mucosa and submucosa
Ulcerative colitis[42]
  • Mononuclear inflammatory infiltrate in lamina propria
  • Crypt abscesses
  • Granulation tissue extending into surrounding submucosa and smooth muscle fibers.
  • Submucosal fibrosis
  • Schwann cell proliferation

References

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