Angiodysplasia differential diagnosis: Difference between revisions

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==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:
 
*[[Diverticulitis]]
*[[Hemorrhoids]]
*[[Colon cancer]]
*Massive [[Upper gastrointestinal bleeding|upper GI bleed]]
*[[Inflammatory bowel disease]]
 
{| class="wikitable sortable"
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |<small>Diseases</small>
| colspan="4" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |<small>Clinical manifestations</small>
! colspan="5" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |<small>Para-clinical findings</small>
| colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |<small>Gold standard</small>
|-
| colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |<small>Symptoms</small>
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |<small>Physical examination</small>
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |<small>Lab Findings</small>
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |<small>Imaging</small>
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |<small>Histopathology</small>
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Abdominal pain
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lower GI Bleed
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Changes in bowel habits, weight loss
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |<small>Characteristic physical examination findings</small>
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |<small>Pertinent laboratory findings</small>
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |<small>Ultrasound/CT scan</small>
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |<small>Endoscopy</small>
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |<small>MRI</small>
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |<small>[[Diverticulitis]]</small><ref name="pmid29710265">{{cite journal| author=Swanson SM, Strate LL| title=Acute Colonic Diverticulitis. | journal=Ann Intern Med | year= 2018 | volume= 168 | issue= 9 | pages= ITC65-ITC80 | pmid=29710265 | doi=10.7326/AITC201805010 | pmc=6430566 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29710265  }} </ref><ref name="pmid17573742">{{cite journal| author=Laurell H, Hansson LE, Gunnarsson U| title=Acute diverticulitis--clinical presentation and differential diagnostics. | journal=Colorectal Dis | year= 2007 | volume= 9 | issue= 6 | pages= 496-501; discussion 501-2 | pmid=17573742 | doi=10.1111/j.1463-1318.2006.01162.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17573742  }} </ref><ref name="pmid20485003">{{cite journal| author=Laméris W, van Randen A, van Gulik TM, Busch OR, Winkelhagen J, Bossuyt PM | display-authors=etal| title=A clinical decision rule to establish the diagnosis of acute diverticulitis at the emergency department. | journal=Dis Colon Rectum | year= 2010 | volume= 53 | issue= 6 | pages= 896-904 | pmid=20485003 | doi=10.1007/DCR.0b013e3181d98d86 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20485003  }} </ref><ref name="pmid33077029">{{cite journal| author=Hawkins AT, Wise PE, Chan T, Lee JT, Glyn T, Wood V | display-authors=etal| title=Diverticulitis: An Update From the Age Old Paradigm. | journal=Curr Probl Surg | year= 2020 | volume= 57 | issue= 10 | pages= 100862 | pmid=33077029 | doi=10.1016/j.cpsurg.2020.100862 | pmc=7575828 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33077029  }} </ref><ref name="pmid6739821">{{cite journal| author=Hulnick DH, Megibow AJ, Balthazar EJ, Naidich DP, Bosniak MA| title=Computed tomography in the evaluation of diverticulitis. | journal=Radiology | year= 1984 | volume= 152 | issue= 2 | pages= 491-5 | pmid=6739821 | doi=10.1148/radiology.152.2.6739821 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6739821  }} </ref><ref name="pmid1418606">{{cite journal| author=Doringer E| title=Computerized tomography of colonic diverticulitis. | journal=Crit Rev Diagn Imaging | year= 1992 | volume= 33 | issue= 5 | pages= 421-35 | pmid=1418606 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1418606  }} </ref><ref name="pmid20676257">{{cite journal| author=Destigter KK, Keating DP| title=Imaging update: acute colonic diverticulitis. | journal=Clin Colon Rectal Surg | year= 2009 | volume= 22 | issue= 3 | pages= 147-55 | pmid=20676257 | doi=10.1055/s-0029-1236158 | pmc=2780264 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20676257  }} </ref><ref name="pmid32483125">{{cite journal| author=Pesce A, Barchitta M, Agodi A, Salerno M, La Greca G, Magro G | display-authors=etal| title=Comparison of clinical and pathological findings of patients undergoing elective colectomy for uncomplicated diverticulitis. | journal=Sci Rep | year= 2020 | volume= 10 | issue= 1 | pages= 8854 | pmid=32483125 | doi=10.1038/s41598-020-65727-1 | pmc=7264214 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32483125  }} </ref>
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<small>+</small>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<small>-</small>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<small>[[Left lower quadrant abdominal pain resident survival guide|Left lower quadrant]] abdominal tenderness, fever</small>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<small>[[Leukocytosis]], elevated [[Erythrocyte sedimentation rate|ESR]] and [[C-reactive protein|CRP]]</small>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<small>[[Radiology|Radiological test]] of choice - CT of abdomen and pelvis with contrast which shows segmental bowel wall thickening, pericolic inflammation, [[abscess]] (30% cases)</small>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<small>Endoscopy is not indicated in [[acute]] diverticulitis due to the risk of [[perforation]]</small>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<small>Findings similar to CT scan</small>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<small>Varying grades of [[inflammation]] seen in surgical specimens</small>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<small>Abdominal [[CT scan|computerized tomography (CT) scan]]</small>
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |<small>[[Hemorrhoids]]</small><ref name="pmid7924705">{{cite journal| author=Kluiber RM, Wolff BG| title=Evaluation of anemia caused by hemorrhoidal bleeding. | journal=Dis Colon Rectum | year= 1994 | volume= 37 | issue= 10 | pages= 1006-7 | pmid=7924705 | doi=10.1007/BF02049313 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7924705 }} </ref><ref name="pmid26309351">{{cite journal| author=Lohsiriwat V| title=Treatment of hemorrhoids: A coloproctologist's view. | journal=World J Gastroenterol | year= 2015 | volume= 21 | issue= 31 | pages= 9245-52 | pmid=26309351 | doi=10.3748/wjg.v21.i31.9245 | pmc=4541377 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26309351  }} </ref><ref name="pmid23715885">{{cite journal| author=Lohsiriwat V| title=Approach to hemorrhoids. | journal=Curr Gastroenterol Rep | year= 2013 | volume= 15 | issue= 7 | pages= 332 | pmid=23715885 | doi=10.1007/s11894-013-0332-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23715885  }} </ref><ref name="pmid21766771">{{cite journal| author=Mounsey AL, Halladay J, Sadiq TS| title=Hemorrhoids. | journal=Am Fam Physician | year= 2011 | volume= 84 | issue= 2 | pages= 204-10 | pmid=21766771 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21766771  }} </ref><ref name="pmid22379400">{{cite journal| author=Sanchez C, Chinn BT| title=Hemorrhoids. | journal=Clin Colon Rectal Surg | year= 2011 | volume= 24 | issue= 1 | pages= 5-13 | pmid=22379400 | doi=10.1055/s-0031-1272818 | pmc=3140328 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22379400  }} </ref><ref name="pmid28611519">{{cite journal| author=Aimaiti A, A Ba Bai Ke Re MMTJ, Ibrahim I, Chen H, Tuerdi M| title=Sonographic appearance of anal cushions of hemorrhoids. | journal=World J Gastroenterol | year= 2017 | volume= 23 | issue= 20 | pages= 3664-3674 | pmid=28611519 | doi=10.3748/wjg.v23.i20.3664 | pmc=5449423 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28611519  }} </ref><ref name="pmid21766771">{{cite journal| author=Mounsey AL, Halladay J, Sadiq TS| title=Hemorrhoids. | journal=Am Fam Physician | year= 2011 | volume= 84 | issue= 2 | pages= 204-10 | pmid=21766771 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21766771  }} </ref>
| style="background: #F5F5F5; padding: 5px; text-align: center;" | - ([[Anus|anal]] pain)
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<small>+</small>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<small>-</small>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<small>[[Acrochordon|Skin tags]], [[fistulas]]/[[Fissure|fissures]], prolapsed [[hemorrhoid]]</small>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<small>[[Complete blood count]] may show [[iron deficiency anemia]]</small>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<small>Ultrasound - "mosaic pattern" of anal cushion in grade III and IV [[Hemorrhoids|internal hemorrhoids]]</small>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<small>[[Anoscopy]] - bulging, dilated purplish-blue veins</small>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<small>MRI is not recommended for the assessment of hemorrhoids</small>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<small>Abnormally dilated, vessels within submucosal arteriovenous plexus</small>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<small>[[Anoscopy]]</small>
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |<small>[[Colon cancer]]</small><ref name="pmid16106247">{{cite journal| author=Hamilton W, Round A, Sharp D, Peters TJ| title=Clinical features of colorectal cancer before diagnosis: a population-based case-control study. | journal=Br J Cancer | year= 2005 | volume= 93 | issue= 4 | pages= 399-405 | pmid=16106247 | doi=10.1038/sj.bjc.6602714 | pmc=2361578 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16106247  }} </ref><ref name="pmid10520866">{{cite journal| author=Majumdar SR, Fletcher RH, Evans AT| title=How does colorectal cancer present? Symptoms, duration, and clues to location. | journal=Am J Gastroenterol | year= 1999 | volume= 94 | issue= 10 | pages= 3039-45 | pmid=10520866 | doi=10.1111/j.1572-0241.1999.01454.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10520866  }} </ref><ref name="pmid8184311">{{cite journal| author=Rizk SN, Ryan JJ| title=Clinicopathologic review of 92 cases of colon cancer. | journal=S D J Med | year= 1994 | volume= 47 | issue= 3 | pages= 89-93 | pmid=8184311 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8184311  }} </ref><ref name="pmid18817021">{{cite journal| author=Saidi HS, Karuri D, Nyaim EO| title=Correlation of clinical data, anatomical site and disease stage in colorectal cancer. | journal=East Afr Med J | year= 2008 | volume= 85 | issue= 6 | pages= 259-62 | pmid=18817021 | doi=10.4314/eamj.v85i6.9622 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18817021  }} </ref><ref name="pmid26602596">{{cite journal| author=Moreno CC, Mittal PK, Sullivan PS, Rutherford R, Staley CA, Cardona K | display-authors=etal| title=Colorectal Cancer Initial Diagnosis: Screening Colonoscopy, Diagnostic Colonoscopy, or Emergent Surgery, and Tumor Stage and Size at Initial Presentation. | journal=Clin Colorectal Cancer | year= 2016 | volume= 15 | issue= 1 | pages= 67-73 | pmid=26602596 | doi=10.1016/j.clcc.2015.07.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26602596  }} </ref><ref name="pmid21619747">{{cite journal| author=Astin M, Griffin T, Neal RD, Rose P, Hamilton W| title=The diagnostic value of symptoms for colorectal cancer in primary care: a systematic review. | journal=Br J Gen Pract | year= 2011 | volume= 61 | issue= 586 | pages= e231-43 | pmid=21619747 | doi=10.3399/bjgp11X572427 | pmc=3080228 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21619747  }} </ref><ref name="pmid26765125">{{cite journal| author=Symonds EL, Pedersen SK, Baker RT, Murray DH, Gaur S, Cole SR | display-authors=etal| title=A Blood Test for Methylated BCAT1 and IKZF1 vs. a Fecal Immunochemical Test for Detection of Colorectal Neoplasia. | journal=Clin Transl Gastroenterol | year= 2016 | volume= 7 | issue=  | pages= e137 | pmid=26765125 | doi=10.1038/ctg.2015.67 | pmc=4737873 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26765125  }} </ref><ref name="pmid31088406">{{cite journal| author=Sun J, Fei F, Zhang M, Li Y, Zhang X, Zhu S | display-authors=etal| title=The role of mSEPT9 in screening, diagnosis, and recurrence monitoring of colorectal cancer. | journal=BMC Cancer | year= 2019 | volume= 19 | issue= 1 | pages= 450 | pmid=31088406 | doi=10.1186/s12885-019-5663-8 | pmc=6518628 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31088406  }} </ref><ref name="pmid26471083">{{cite journal| author=Song L, Li Y| title=SEPT9: A Specific Circulating Biomarker for Colorectal Cancer. | journal=Adv Clin Chem | year= 2015 | volume= 72 | issue=  | pages= 171-204 | pmid=26471083 | doi=10.1016/bs.acc.2015.07.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26471083  }} </ref><ref name="pmid20829538">{{cite journal| author=Niekel MC, Bipat S, Stoker J| title=Diagnostic imaging of colorectal liver metastases with CT, MR imaging, FDG PET, and/or FDG PET/CT: a meta-analysis of prospective studies including patients who have not previously undergone treatment. | journal=Radiology | year= 2010 | volume= 257 | issue= 3 | pages= 674-84 | pmid=20829538 | doi=10.1148/radiol.10100729 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20829538 }} </ref><ref name="pmid27982025">{{cite journal| author=Shia J, Schultz N, Kuk D, Vakiani E, Middha S, Segal NH | display-authors=etal| title=Morphological characterization of colorectal cancers in The Cancer Genome Atlas reveals distinct morphology-molecular associations: clinical and biological implications. | journal=Mod Pathol | year= 2017 | volume= 30 | issue= 4 | pages= 599-609 | pmid=27982025 | doi=10.1038/modpathol.2016.198 | pmc=5380525 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27982025 }} </ref>
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<small>[[Lymphadenopathy|Lymphadenopathies]], abdominal mass, [[hepatomegaly]] ([[metastasis]])</small>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<small>Complete blood count - iron deficiency anemia, [[Tumor markers|tumor marker]] - [[CEA]], methylated circulating DNA markers</small>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<small>CT scan shows soft tissue mass causing narrowing of colonic lumen or asymmetric bowel wall thickening.</small>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<small>Colonoscopy reveals mass protruding from the mucosa to the lumen which may sometimes bleed on touching</small>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<small>MRI is better than CT to detect liver metastasis</small>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<small>Majority of colorectal cancers are adenocarcinomas characterised by glandular formation</small>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<small>[[Colonoscopy]]</small>
|-
| style="background: #DCDCDC; padding: 5px;  text-align: center;" |<small>Massive [[Upper gastrointestinal bleeding|upper GI bleed]]</small><ref name="pmid32109037">{{cite journal| author=Wilkins T, Wheeler B, Carpenter M| title=Upper Gastrointestinal Bleeding in Adults: Evaluation and Management. | journal=Am Fam Physician | year= 2020 | volume= 101 | issue= 5 | pages= 294-300 | pmid=32109037 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32109037  }} </ref><ref name="pmid21932501">{{cite journal| author=Hopper AD, Sanders DS| title=Upper GI bleeding requires prompt investigation. | journal=Practitioner | year= 2011 | volume= 255 | issue= 1742 | pages= 15-9, 2 | pmid=21932501 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21932501 }} </ref><ref name="pmid26417980">{{cite journal| author=Gralnek IM, Dumonceau JM, Kuipers EJ, Lanas A, Sanders DS, Kurien M | display-authors=etal| title=Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. | journal=Endoscopy | year= 2015 | volume= 47 | issue= 10 | pages= a1-46 | pmid=26417980 | doi=10.1055/s-0034-1393172 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26417980  }} </ref><ref name="pmid22416103">{{cite journal| author=Srygley FD, Gerardo CJ, Tran T, Fisher DA| title=Does this patient have a severe upper gastrointestinal bleed? | journal=JAMA | year= 2012 | volume= 307 | issue= 10 | pages= 1072-9 | pmid=22416103 | doi=10.1001/jama.2012.253 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22416103  }} </ref><ref name="pmid2229992">{{cite journal| author=Richards RJ, Donica MB, Grayer D| title=Can the blood urea nitrogen/creatinine ratio distinguish upper from lower gastrointestinal bleeding? | journal=J Clin Gastroenterol | year= 1990 | volume= 12 | issue= 5 | pages= 500-4 | pmid=2229992 | doi=10.1097/00004836-199010000-00004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2229992  }} </ref>
| style="background: #F5F5F5; padding: 5px;  text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<small>-</small>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<small>[[Hemodynamic instability]], upper abdominal [[tenderness]], pale skin</small>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<small>Complete blood count in acute bleeding - [[normocytic anemia]]. Elevated BUN-to-Creatinine ratio >30:1</small>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<small>CT angiography localises the site of GI bleed</small>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<small>Upper GI endoscopy can play a diagnostic and therapeutic role in localising and stopping the bleed</small>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<small>MRI is not indicated</small>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |NA
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<small>[[Endoscopy]]</small>
|-
| style="background: #DCDCDC; padding: 5px;  text-align: center;" |<small>[[Inflammatory bowel disease]]</small><ref name="pmid31406511">{{cite journal| author=Seyedian SS, Nokhostin F, Malamir MD| title=A review of the diagnosis, prevention, and treatment methods of inflammatory bowel disease. | journal=J Med Life | year= 2019 | volume= 12 | issue= 2 | pages= 113-122 | pmid=31406511 | doi=10.25122/jml-2018-0075 | pmc=6685307 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31406511  }} </ref><ref name="pmid26414706">{{cite journal| author=Rosen MJ, Dhawan A, Saeed SA| title=Inflammatory Bowel Disease in Children and Adolescents. | journal=JAMA Pediatr | year= 2015 | volume= 169 | issue= 11 | pages= 1053-60 | pmid=26414706 | doi=10.1001/jamapediatrics.2015.1982 | pmc=4702263 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26414706  }} </ref><ref name="pmid31760611">{{cite journal| author=Nocerino A, Nguyen A, Agrawal M, Mone A, Lakhani K, Swaminath A| title=Fatigue in Inflammatory Bowel Diseases: Etiologies and Management. | journal=Adv Ther | year= 2020 | volume= 37 | issue= 1 | pages= 97-112 | pmid=31760611 | doi=10.1007/s12325-019-01151-w | pmc=6979464 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31760611  }} </ref><ref name="pmid16698746">{{cite journal| author=Satsangi J, Silverberg MS, Vermeire S, Colombel JF| title=The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. | journal=Gut | year= 2006 | volume= 55 | issue= 6 | pages= 749-53 | pmid=16698746 | doi=10.1136/gut.2005.082909 | pmc=1856208 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16698746  }} </ref><ref name="pmid20634346">{{cite journal| author=van Rheenen PF, Van de Vijver E, Fidler V| title=Faecal calprotectin for screening of patients with suspected inflammatory bowel disease: diagnostic meta-analysis. | journal=BMJ | year= 2010 | volume= 341 | issue=  | pages= c3369 | pmid=20634346 | doi=10.1136/bmj.c3369 | pmc=2904879 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20634346  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=21242354 Review in: Ann Intern Med. 2011 Jan 18;154(2):JC1-12] </ref><ref name="pmid28406440">{{cite journal| author=Pan Y, Liu Y, Guo H, Jabir MS, Liu X, Cui W | display-authors=etal| title=Associations between Folate and Vitamin B12 Levels and Inflammatory Bowel Disease: A Meta-Analysis. | journal=Nutrients | year= 2017 | volume= 9 | issue= 4 | pages=  | pmid=28406440 | doi=10.3390/nu9040382 | pmc=5409721 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28406440  }} </ref><ref name="pmid22832510">{{cite journal| author=Alkhouri RH, Hashmi H, Baker RD, Gelfond D, Baker SS| title=Vitamin and mineral status in patients with inflammatory bowel disease. | journal=J Pediatr Gastroenterol Nutr | year= 2013 | volume= 56 | issue= 1 | pages= 89-92 | pmid=22832510 | doi=10.1097/MPG.0b013e31826a105d | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22832510  }} </ref><ref name="pmid21912467">{{cite journal| author=Strobel D, Goertz RS, Bernatik T| title=Diagnostics in inflammatory bowel disease: ultrasound. | journal=World J Gastroenterol | year= 2011 | volume= 17 | issue= 27 | pages= 3192-7 | pmid=21912467 | doi=10.3748/wjg.v17.i27.3192 | pmc=3158394 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21912467  }} </ref><ref name="pmid30254405">{{cite journal| author=Spiceland CM, Lodhia N| title=Endoscopy in inflammatory bowel disease: Role in diagnosis, management, and treatment. | journal=World J Gastroenterol | year= 2018 | volume= 24 | issue= 35 | pages= 4014-4020 | pmid=30254405 | doi=10.3748/wjg.v24.i35.4014 | pmc=6148432 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30254405  }} </ref><ref name="pmid21512607">{{cite journal| author=Gee MS, Harisinghani MG| title=MRI in patients with inflammatory bowel disease. | journal=J Magn Reson Imaging | year= 2011 | volume= 33 | issue= 3 | pages= 527-34 | pmid=21512607 | doi=10.1002/jmri.22504 | pmc=3078716 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21512607  }} </ref>
| style="background: #F5F5F5; padding: 5px;  text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<small>+/-</small>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<small>+</small>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<small>[[Tachycardia]], [[fever]], occult blood on [[Digital rectal examination|digital rectal examinaton]], anal fistulas</small>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*<small>Complete blood count - [[microcytic anemia]], leukocytosis.</small>
*<small>Elevated ESR, CRP,</small>
*<small>Elevated fecal  calprotectin  (non-specific),</small>
*<small>Low serum [[Vitamin B12 deficiency|vitamin B12]] and [[Folate deficiency|folate]] levels,</small>
*<small>Anti-Saccaromyces cerevisiae antibodies (ASCA) - Crohn's disease.</small>
*<small>Anti-neutrophil cytoplasm antibodies ('''p-ANCA''')-Ulcerative colitis.</small>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<small>CT scan - Ulcerative colitis presents as thinning of bowel wall whereas, active Crohn's disease presents as bowel wall thickening with hyperenhancement of mucosa.</small>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<small>Colonoscopy in:</small>
*<small>Ulcerative colitis - edematous mucosa, decreased vascular markings, erosions.</small>
*<small>Crohn's disease - discontinuous ulcers, cobblestone appearance of mucosa.</small>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<small>Pelvi MRI for perianal involvement</small>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<small>UC- crypt abscess</small>
<small>Crohn's- transmural involvement, granulomas</small>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<small>Endoscopy</small>
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |<small>[[Angiodysplasia]]</small><ref name="pmid19260627">{{cite journal| author=Tonea A, Andrei S, Andronesi D, Ionescu M, Gheorghe C, Herlea V | display-authors=etal| title=[Difficulties in diagnosis and surgical treatment of the angiodysplasia of the gastrointestinal tract]. | journal=Chirurgia (Bucur) | year= 2008 | volume= 103 | issue= 5 | pages= 513-28 | pmid=19260627 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19260627  }} </ref><ref name="pmid3500991">{{cite journal| author=Danesh BJ, Spiliadis C, Williams CB, Zambartas CM| title=Angiodysplasia--an uncommon cause of colonic bleeding: colonoscopic evaluation of 1,050 patients with rectal bleeding and anaemia. | journal=Int J Colorectal Dis | year= 1987 | volume= 2 | issue= 4 | pages= 218-22 | pmid=3500991 | doi=10.1007/BF01649509 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3500991  }} </ref><ref name="pmid6123752">{{cite journal| author=Howard OM, Buchanan JD, Hunt RH| title=Angiodysplasia of the colon. Experience of 26 cases. | journal=Lancet | year= 1982 | volume= 2 | issue= 8288 | pages= 16-9 | pmid=6123752 | doi=10.1016/s0140-6736(82)91153-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6123752  }} </ref><ref name="pmid6980903">{{cite journal| author=Pounder DJ, Rowland R, Pieterse AS, Freeman R, Hunter R| title=Angiodysplasias of the colon. | journal=J Clin Pathol | year= 1982 | volume= 35 | issue= 8 | pages= 824-9 | pmid=6980903 | doi=10.1136/jcp.35.8.824 | pmc=497797 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6980903  }} </ref>
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[Occult]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<small>-</small>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<small>[[Signs]] of anemia, [[systolic ejection murmur]] (if [[aortic stenosis]]), rarely, [[orthostasis]] or [[hypotension]]</small>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
*<small>Complete blood count - microcytic anemia.</small>
*<small>[[Coagulation studies]]</small>
*<small>[[Renal function tests|Renal]] and [[liver function tests]],</small>
*<small>[[Fecal occult blood test|Stool for occult blood]] may be positive.</small>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<small>CT angiography - focal areas of contrast enhancement, early filling veins</small>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<small>Upper GI endoscopy and colonoscopy:  discrete, small foci with arborizing pattern from a visible central artery</small><br />
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<small>MRA may be used</small>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<small>Tortuous, dilated veins, venules and capillaries in the colonic mucosa and submucosa</small>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<small>Endoscopy</small>
|}


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


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Latest revision as of 10:42, 15 October 2021

Angiodysplasia Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Nikita Singh, M.B.B.S.[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 Characteristic physical examination findings Pertinent laboratory findings Ultrasound/CT scan Endoscopy MRI
Diverticulitis[1][2][3][4][5][6][7][8] + + - Left lower quadrant abdominal tenderness, fever Leukocytosis, elevated ESR and CRP Radiological test of choice - CT of abdomen and pelvis with contrast which shows segmental bowel wall thickening, pericolic inflammation, abscess (30% cases) Endoscopy is not indicated in acute diverticulitis due to the risk of perforation Findings similar to CT scan Varying grades of inflammation seen in surgical specimens Abdominal computerized tomography (CT) scan
Hemorrhoids[9][10][11][12][13][14][12] - (anal pain) + - Skin tags, fistulas/fissures, prolapsed hemorrhoid Complete blood count may show iron deficiency anemia Ultrasound - "mosaic pattern" of anal cushion in grade III and IV internal hemorrhoids Anoscopy - bulging, dilated purplish-blue veins MRI is not recommended for the assessment of hemorrhoids Abnormally dilated, vessels within submucosal arteriovenous plexus Anoscopy
Colon cancer[15][16][17][18][19][20][21][22][23][24][25] +/- +/- + Lymphadenopathies, abdominal mass, hepatomegaly (metastasis) Complete blood count - iron deficiency anemia, tumor marker - CEA, methylated circulating DNA markers CT scan shows soft tissue mass causing narrowing of colonic lumen or asymmetric bowel wall thickening. Colonoscopy reveals mass protruding from the mucosa to the lumen which may sometimes bleed on touching MRI is better than CT to detect liver metastasis Majority of colorectal cancers are adenocarcinomas characterised by glandular formation Colonoscopy
Massive upper GI bleed[26][27][28][29][30] + + - Hemodynamic instability, upper abdominal tenderness, pale skin Complete blood count in acute bleeding - normocytic anemia. Elevated BUN-to-Creatinine ratio >30:1 CT angiography localises the site of GI bleed Upper GI endoscopy can play a diagnostic and therapeutic role in localising and stopping the bleed MRI is not indicated NA Endoscopy
Inflammatory bowel disease[31][32][33][34][35][36][37][38][39][40] + +/- + Tachycardia, fever, occult blood on digital rectal examinaton, anal fistulas
  • Complete blood count - microcytic anemia, leukocytosis.
  • Elevated ESR, CRP,
  • Elevated fecal calprotectin (non-specific),
  • Low serum vitamin B12 and folate levels,
  • Anti-Saccaromyces cerevisiae antibodies (ASCA) - Crohn's disease.
  • Anti-neutrophil cytoplasm antibodies (p-ANCA)-Ulcerative colitis.
 CT scan - Ulcerative colitis presents as thinning of bowel wall whereas, active Crohn's disease presents as bowel wall thickening with hyperenhancement of mucosa. Colonoscopy in:
  • Ulcerative colitis - edematous mucosa, decreased vascular markings, erosions.
  • Crohn's disease - discontinuous ulcers, cobblestone appearance of mucosa.
 Pelvi MRI for perianal involvement UC- crypt abscess

Crohn's- transmural involvement, granulomas

Endoscopy
Angiodysplasia[41][42][43][44] - Occult - Signs of anemia, systolic ejection murmur (if aortic stenosis), rarely, orthostasis or hypotension CT angiography - focal areas of contrast enhancement, early filling veins Upper GI endoscopy and colonoscopy: discrete, small foci with arborizing pattern from a visible central artery
 MRA may be used Tortuous, dilated veins, venules and capillaries in the colonic mucosa and submucosa Endoscopy

References

  1. ↑ Swanson SM, Strate LL (2018). "Acute Colonic Diverticulitis". Ann Intern Med. 168 (9): ITC65–ITC80. doi:10.7326/AITC201805010. PMC 6430566. PMID 29710265.
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ 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).
  5. ↑ Hulnick DH, Megibow AJ, Balthazar EJ, Naidich DP, Bosniak MA (1984). "Computed tomography in the evaluation of diverticulitis". Radiology. 152 (2): 491–5. doi:10.1148/radiology.152.2.6739821. PMID 6739821.
  6. ↑ Doringer E (1992). "Computerized tomography of colonic diverticulitis". Crit Rev Diagn Imaging. 33 (5): 421–35. PMID 1418606.
  7. ↑ Destigter KK, Keating DP (2009). "Imaging update: acute colonic diverticulitis". Clin Colon Rectal Surg. 22 (3): 147–55. doi:10.1055/s-0029-1236158. PMC 2780264. PMID 20676257.
  8. ↑ Pesce A, Barchitta M, Agodi A, Salerno M, La Greca G, Magro G; et al. (2020). "Comparison of clinical and pathological findings of patients undergoing elective colectomy for uncomplicated diverticulitis". Sci Rep. 10 (1): 8854. doi:10.1038/s41598-020-65727-1. PMC 7264214 Check |pmc= value (help). PMID 32483125 Check |pmid= value (help).
  9. ↑ 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.
  10. ↑ 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.
  11. ↑ Lohsiriwat V (2013). "Approach to hemorrhoids". Curr Gastroenterol Rep. 15 (7): 332. doi:10.1007/s11894-013-0332-6. PMID 23715885.
  12. ↑ 12.0 12.1 Mounsey AL, Halladay J, Sadiq TS (2011). "Hemorrhoids". Am Fam Physician. 84 (2): 204–10. PMID 21766771.
  13. ↑ Sanchez C, Chinn BT (2011). "Hemorrhoids". Clin Colon Rectal Surg. 24 (1): 5–13. doi:10.1055/s-0031-1272818. PMC 3140328. PMID 22379400.
  14. ↑ Aimaiti A, A Ba Bai Ke Re MMTJ, Ibrahim I, Chen H, Tuerdi M (2017). "Sonographic appearance of anal cushions of hemorrhoids". World J Gastroenterol. 23 (20): 3664–3674. doi:10.3748/wjg.v23.i20.3664. PMC 5449423. PMID 28611519.
  15. ↑ 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.
  16. ↑ 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.
  17. ↑ Rizk SN, Ryan JJ (1994). "Clinicopathologic review of 92 cases of colon cancer". S D J Med. 47 (3): 89–93. PMID 8184311.
  18. ↑ 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.
  19. ↑ 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.
  20. ↑ 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.
  21. ↑ Symonds EL, Pedersen SK, Baker RT, Murray DH, Gaur S, Cole SR; et al. (2016). "A Blood Test for Methylated BCAT1 and IKZF1 vs. a Fecal Immunochemical Test for Detection of Colorectal Neoplasia". Clin Transl Gastroenterol. 7: e137. doi:10.1038/ctg.2015.67. PMC 4737873. PMID 26765125.
  22. ↑ Sun J, Fei F, Zhang M, Li Y, Zhang X, Zhu S; et al. (2019). "The role of mSEPT9 in screening, diagnosis, and recurrence monitoring of colorectal cancer". BMC Cancer. 19 (1): 450. doi:10.1186/s12885-019-5663-8. PMC 6518628 Check |pmc= value (help). PMID 31088406.
  23. ↑ Song L, Li Y (2015). "SEPT9: A Specific Circulating Biomarker for Colorectal Cancer". Adv Clin Chem. 72: 171–204. doi:10.1016/bs.acc.2015.07.004. PMID 26471083.
  24. ↑ Niekel MC, Bipat S, Stoker J (2010). "Diagnostic imaging of colorectal liver metastases with CT, MR imaging, FDG PET, and/or FDG PET/CT: a meta-analysis of prospective studies including patients who have not previously undergone treatment". Radiology. 257 (3): 674–84. doi:10.1148/radiol.10100729. PMID 20829538.
  25. ↑ Shia J, Schultz N, Kuk D, Vakiani E, Middha S, Segal NH; et al. (2017). "Morphological characterization of colorectal cancers in The Cancer Genome Atlas reveals distinct morphology-molecular associations: clinical and biological implications". Mod Pathol. 30 (4): 599–609. doi:10.1038/modpathol.2016.198. PMC 5380525. PMID 27982025.
  26. ↑ 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).
  27. ↑ Hopper AD, Sanders DS (2011). "Upper GI bleeding requires prompt investigation". Practitioner. 255 (1742): 15–9, 2. PMID 21932501.
  28. ↑ 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.
  29. ↑ Srygley FD, Gerardo CJ, Tran T, Fisher DA (2012). "Does this patient have a severe upper gastrointestinal bleed?". JAMA. 307 (10): 1072–9. doi:10.1001/jama.2012.253. PMID 22416103.
  30. ↑ Richards RJ, Donica MB, Grayer D (1990). "Can the blood urea nitrogen/creatinine ratio distinguish upper from lower gastrointestinal bleeding?". J Clin Gastroenterol. 12 (5): 500–4. doi:10.1097/00004836-199010000-00004. PMID 2229992.
  31. ↑ 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.
  32. ↑ 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.
  33. ↑ 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.
  34. ↑ 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.
  35. ↑ van Rheenen PF, Van de Vijver E, Fidler V (2010). "Faecal calprotectin for screening of patients with suspected inflammatory bowel disease: diagnostic meta-analysis". BMJ. 341: c3369. doi:10.1136/bmj.c3369. PMC 2904879. PMID 20634346. Review in: Ann Intern Med. 2011 Jan 18;154(2):JC1-12
  36. ↑ Pan Y, Liu Y, Guo H, Jabir MS, Liu X, Cui W; et al. (2017). "Associations between Folate and Vitamin B12 Levels and Inflammatory Bowel Disease: A Meta-Analysis". Nutrients. 9 (4). doi:10.3390/nu9040382. PMC 5409721. PMID 28406440.
  37. ↑ Alkhouri RH, Hashmi H, Baker RD, Gelfond D, Baker SS (2013). "Vitamin and mineral status in patients with inflammatory bowel disease". J Pediatr Gastroenterol Nutr. 56 (1): 89–92. doi:10.1097/MPG.0b013e31826a105d. PMID 22832510.
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  41. ↑ 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.
  42. ↑ 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.
  43. ↑ 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.
  44. ↑ 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.

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