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home - Miscellaneous - Vascular Lesions - Vascular Lesions Written by Dr Sebastian Zeki

Vascular Lesions

Uncommon causes of upper GI bleeding Dieulafoy’s Lesion: Treatment —1. Thermal coagulation2. TIPS doesnt work3. Antrectomy 4. Combination oestrogen/progesterone therapy decreased UGI bleeding in one report, although the ectatic vessels persisted. Treatment — Based on reducing Portal hypertension1. Propranolol2. TIPS may show some improvement in PHTN3. Endoscopic thermal coagulation is effective for focally bleeding angiomas associated with cirrhosis.Ineffective:Thermal coagulationInjection therapyH2-blockersSucralfateSurgical resection Haemosuccus Pancreaticus -Bleeding from the pancreatic duct) —Occurs when a pseudocyst or tumor erodes into a vessel.Dx:CT scan.Treatment:Mesenteric arteriography with coil embolization can control acute bleedingIf bleeding persists or is massive, pancreaticoduodenectomy or pseudocyst resection and ligation of the bleeding vessel definitively prevents rebleeding. Areas: D3 and D4 >jejunum and ileum.Presention: Massive bleedingCauses:AAA in WestInfectious aortitis due to syphilis or TB/ AAA graft.Penetrating ulcer, Tumor invasion, Trauma, Radiation therapyForeign body perforation.Diagnosis —Endoscopy or surgery (CT not useful)Treatment —Always need surgery with bypass Cameron LesionsThese are ulcers occurring in the sac of a hiatal hernia.The prevalence is 5% of patients with hiatus hernia.They are caused by reflux esophagitis and mechanical trauma. Related to degree of portal pressure Histology: Extensive edema in more severe cases, with capillary and venous dilatation in the submu-cosa extending into the mucosa. Stable in 29 % Deteriorated in 23 % Improved in 23 % Fluctuated in 25 %. Capillary calibre 10x normalLocation: Upper stomach along the lesser curvature/ can occur anywhere Diagnosis —Visible vessel or arterial pumping without ulcerCan be confirmed with EUS Rebleeding risk of around 20% so it may help to tattoo the area after treatment Treatment —Endoscopy: Usually adrenaline/ clipsSurgery: Wedge resection rather than siple oversewing if rebleeding a problem Aetiology: Probably congenital. Gastric Antral Vascular Ectasia (=GAVE= Watermelon stomach): Endoscopically: Ectatic and sacculated mucosal vessels in antrum.Punctate form more common in cirrhosis Histopathology: Vascular ectasia, spindle cell proliferation, and fibrohyalinosis. Diagnosis —Biopsy/ EUS/Tagged RCC/ CT Causes:Idiopathic (usually)CirrhosisSystemic sclerosis Haemobilia: Bleeding from the hepatobiliary tractCause: Damage to hpb tractPresentation: Triad of hemobilia includes biliary colic, obstructive jaundice, and occult or acute GI bleeding. Snakeskin Mucosa Portal Hyperten-sive Gastropathy Aortoenteric Fistulas Written by Dr Sebastian Zeki Incidence: Elderly/Female

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