Angiodysplasia differential diagnosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Nikita Singh, M.D.[2]
Overview
Angiodysplasia must be differentiated from other diseases that cause hematochezia, melena, and iron deficiency anemia, such as hemorrhoids, diverticular disease, and colon cancer.
Differentiating Angiodysplasia from other Diseases
Angiodysplasia must be differentiated from other diseases that cause hematochezia, melena, and iron deficiency anemia such as:
| Diseases | Clinical manifestations | Para-clinical findings | Gold standard | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Symptoms | Physical examination | |||||||||||||
| Lab Findings | Imaging | Histopathology | ||||||||||||
| Abdominal pain | Lower GI Bleed | Changes in bowel habits, weight loss | Physical exam 1 | Physical exam 2 | Physical exam 3 | Lab 1 | Lab 2 | Lab 3 | Imaging 1 | Imaging 2 | Imaging 3 | |||
| Diverticulitis[1][2][3] | + | + | - | Left lower quadrant abdominal tenderness | Bowel sounds hypoactive/normoactive | Fever | Leukocytosis | Elevated ESR and CRP | Radiological test of choice - CT of abdomen and pelvis with contrast | Abdominal Ultrasound | MRI abdomen | Colonoscopy after resolution of inflammation | ||
| Hemorrhoids[4][5][6][7][8] | - (anal pain) | + | - | Skin tags | Fistulas or fissures | Prolapsed hemorrhoid | External hemorrhoids - distal to dentate line.
Internal hemorrhoids - proximal to dentate line. |
Anoscopy | ||||||
| Colon cancer[9][10][11][12][13][14] | +/- | +/- | + | Lmyphadenopathies | Abdominal mass | Hepatomegaly (metastasis) | Tumor marker - CEA | CT with contrast chest, abdomen and pelvis | Majority of colorectal cancers are carcinomas. | Colonoscopy | ||||
| Massive upper GI bleed[15][16][17] | + | + | - | Hemodynamic instability | Upper abdominal tenderness | Pale skin | Acute bleeding - normocytic anemia | Elevated BUN-to-Creatinine ratio >30:1 | CT angiography | Endoscopy | ||||
| Inflammatory bowel disease[18][19][20][21] | + | +/- | + | Tachycardia, fever, | Occult blood on digital rectal exam | Anal fistulas, abscesses | Microcytic anemia | Leukocytosis | Elevated ESR, CRP | Abdominal X ray - free air, bowel obstruction, toxic megacolon | Barium studies | Ultrasound/CT/MRI | UC- crypt abscess
Crohn's- transmural involvement, granulomas |
Endoscopy |
| Angiodysplasia[22][23][24][25] | - | Occult | - | Signs of anemia | Systolic ejection murmur (if aortic stenosis) | Rarely, orthostasis or hypotension | Microcytic anemia | Renal and liver function tests | Coagulation studies | Radionuclide scanning | CTA/MRA | Upper GI endoscopy and colonoscopy | Tortuous, dilated veins, venules and capillaries in the colonic mucosa and submucosa | Endoscopy |
References
- ↑ Laurell H, Hansson LE, Gunnarsson U (2007). "Acute diverticulitis--clinical presentation and differential diagnostics". Colorectal Dis. 9 (6): 496–501, discussion 501-2. doi:10.1111/j.1463-1318.2006.01162.x. PMID 17573742.
- ↑ Laméris W, van Randen A, van Gulik TM, Busch OR, Winkelhagen J, Bossuyt PM; et al. (2010). "A clinical decision rule to establish the diagnosis of acute diverticulitis at the emergency department". Dis Colon Rectum. 53 (6): 896–904. doi:10.1007/DCR.0b013e3181d98d86. PMID 20485003.
- ↑ Hawkins AT, Wise PE, Chan T, Lee JT, Glyn T, Wood V; et al. (2020). "Diverticulitis: An Update From the Age Old Paradigm". Curr Probl Surg. 57 (10): 100862. doi:10.1016/j.cpsurg.2020.100862. PMC 7575828 Check
|pmc=value (help). PMID 33077029 Check|pmid=value (help). - ↑ Kluiber RM, Wolff BG (1994). "Evaluation of anemia caused by hemorrhoidal bleeding". Dis Colon Rectum. 37 (10): 1006–7. doi:10.1007/BF02049313. PMID 7924705.
- ↑ Lohsiriwat V (2015). "Treatment of hemorrhoids: A coloproctologist's view". World J Gastroenterol. 21 (31): 9245–52. doi:10.3748/wjg.v21.i31.9245. PMC 4541377. PMID 26309351.
- ↑ Lohsiriwat V (2013). "Approach to hemorrhoids". Curr Gastroenterol Rep. 15 (7): 332. doi:10.1007/s11894-013-0332-6. PMID 23715885.
- ↑ Mounsey AL, Halladay J, Sadiq TS (2011). "Hemorrhoids". Am Fam Physician. 84 (2): 204–10. PMID 21766771.
- ↑ Sanchez C, Chinn BT (2011). "Hemorrhoids". Clin Colon Rectal Surg. 24 (1): 5–13. doi:10.1055/s-0031-1272818. PMC 3140328. PMID 22379400.
- ↑ Hamilton W, Round A, Sharp D, Peters TJ (2005). "Clinical features of colorectal cancer before diagnosis: a population-based case-control study". Br J Cancer. 93 (4): 399–405. doi:10.1038/sj.bjc.6602714. PMC 2361578. PMID 16106247.
- ↑ Majumdar SR, Fletcher RH, Evans AT (1999). "How does colorectal cancer present? Symptoms, duration, and clues to location". Am J Gastroenterol. 94 (10): 3039–45. doi:10.1111/j.1572-0241.1999.01454.x. PMID 10520866.
- ↑ Rizk SN, Ryan JJ (1994). "Clinicopathologic review of 92 cases of colon cancer". S D J Med. 47 (3): 89–93. PMID 8184311.
- ↑ Saidi HS, Karuri D, Nyaim EO (2008). "Correlation of clinical data, anatomical site and disease stage in colorectal cancer". East Afr Med J. 85 (6): 259–62. doi:10.4314/eamj.v85i6.9622. PMID 18817021.
- ↑ Moreno CC, Mittal PK, Sullivan PS, Rutherford R, Staley CA, Cardona K; et al. (2016). "Colorectal Cancer Initial Diagnosis: Screening Colonoscopy, Diagnostic Colonoscopy, or Emergent Surgery, and Tumor Stage and Size at Initial Presentation". Clin Colorectal Cancer. 15 (1): 67–73. doi:10.1016/j.clcc.2015.07.004. PMID 26602596.
- ↑ Astin M, Griffin T, Neal RD, Rose P, Hamilton W (2011). "The diagnostic value of symptoms for colorectal cancer in primary care: a systematic review". Br J Gen Pract. 61 (586): e231–43. doi:10.3399/bjgp11X572427. PMC 3080228. PMID 21619747.
- ↑ Wilkins T, Wheeler B, Carpenter M (2020). "Upper Gastrointestinal Bleeding in Adults: Evaluation and Management". Am Fam Physician. 101 (5): 294–300. PMID 32109037 Check
|pmid=value (help). - ↑ Hopper AD, Sanders DS (2011). "Upper GI bleeding requires prompt investigation". Practitioner. 255 (1742): 15–9, 2. PMID 21932501.
- ↑ Gralnek IM, Dumonceau JM, Kuipers EJ, Lanas A, Sanders DS, Kurien M; et al. (2015). "Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline". Endoscopy. 47 (10): a1–46. doi:10.1055/s-0034-1393172. PMID 26417980.
- ↑ Seyedian SS, Nokhostin F, Malamir MD (2019). "A review of the diagnosis, prevention, and treatment methods of inflammatory bowel disease". J Med Life. 12 (2): 113–122. doi:10.25122/jml-2018-0075. PMC 6685307 Check
|pmc=value (help). PMID 31406511. - ↑ Rosen MJ, Dhawan A, Saeed SA (2015). "Inflammatory Bowel Disease in Children and Adolescents". JAMA Pediatr. 169 (11): 1053–60. doi:10.1001/jamapediatrics.2015.1982. PMC 4702263. PMID 26414706.
- ↑ Nocerino A, Nguyen A, Agrawal M, Mone A, Lakhani K, Swaminath A (2020). "Fatigue in Inflammatory Bowel Diseases: Etiologies and Management". Adv Ther. 37 (1): 97–112. doi:10.1007/s12325-019-01151-w. PMC 6979464 Check
|pmc=value (help). PMID 31760611. - ↑ Satsangi J, Silverberg MS, Vermeire S, Colombel JF (2006). "The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications". Gut. 55 (6): 749–53. doi:10.1136/gut.2005.082909. PMC 1856208. PMID 16698746.
- ↑ Tonea A, Andrei S, Andronesi D, Ionescu M, Gheorghe C, Herlea V; et al. (2008). "[Difficulties in diagnosis and surgical treatment of the angiodysplasia of the gastrointestinal tract]". Chirurgia (Bucur). 103 (5): 513–28. PMID 19260627.
- ↑ Danesh BJ, Spiliadis C, Williams CB, Zambartas CM (1987). "Angiodysplasia--an uncommon cause of colonic bleeding: colonoscopic evaluation of 1,050 patients with rectal bleeding and anaemia". Int J Colorectal Dis. 2 (4): 218–22. doi:10.1007/BF01649509. PMID 3500991.
- ↑ Howard OM, Buchanan JD, Hunt RH (1982). "Angiodysplasia of the colon. Experience of 26 cases". Lancet. 2 (8288): 16–9. doi:10.1016/s0140-6736(82)91153-9. PMID 6123752.
- ↑ Pounder DJ, Rowland R, Pieterse AS, Freeman R, Hunter R (1982). "Angiodysplasias of the colon". J Clin Pathol. 35 (8): 824–9. doi:10.1136/jcp.35.8.824. PMC 497797. PMID 6980903.