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 | Systemic symptoms (weight loss, sweats) | 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][4] | + | + | - | 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 | - (anal pain) | + | - | Skin tags | Fistulas or fissures | Prolapsed hemorrhoid | External hemorrhoids - distal to dentate line.
Internal hemorrhoids - proximal to dentate line. |
Anoscopy | ||||||
| Colon cancer | +/- | +/- | + | 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 | + | + | - | Hemodynamic instability | Upper abdominal tenderness | Pale skin | Acute bleeding - normocytic anemia | Elevated BUN-to-Creatinine ratio >30:1 | CT angiography | Endoscopy | ||||
| Inflammatory bowel disease | + | +/- | + | 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 | - | 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
- ↑ Swanson SM, Strate LL (2018). "Acute Colonic Diverticulitis". Ann Intern Med. 168 (9): ITC65–ITC80. doi:10.7326/AITC201805010. PMC 6430566. PMID 29710265.
- ↑ 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).