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Query: UMLS:C0023890 (cirrhosis)
 42,195 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In the recent four years, 8 cases of gastrointestinal angiodysplasia (a.d.) were observed by the authors. Analysing the conclusions drawn from the patients course of disease, they found a.d. to be the cause of an unknown gastrointestinal bleeding. a.d. can be basically diagnosed by angiography. It is often associated with liver cirrhosis or arteriostenosis. The treatment of a.d. is surgical. The recurrence and repeated appearance of bleeding can be expected even after a thoroughly performed resection.
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PMID:Gastrointestinal angiodysplasia. 178 23

We treated a 68-year-old man with cirrhosis of the liver associated with moderate hypoxemia. Contrast-enhanced echocardiography revealed late opacification of the left ventricle, and pulmonary perfusion imaging with 99mTc macroaggregated albumin showed evidence of a significant uptake in both lungs and in the liver, spleen, and kidneys. Right cardiac catheterization revealed pulmonary hypotension, low pulmonary vascular resistance, and high cardiac output. We administered prostaglandin F2 alpha intravenously (0.2 microgram/kg/min for 30 minutes) and indomethacin orally (75 mg/day for three days). There was some degree of resolution of the hypoxemia and increases in both pulmonary arterial pressure and pulmonary vascular resistance. These findings suggest that the pathophysiology of hepatogenic pulmonary angiodysplasia is a reversible intrapulmonary vascular dilatation. These conditions can to some extent be modulated by vasoactive substances such as prostaglandins or other eicosanoids.
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PMID:Prostaglandin F2 alpha and indomethacin in hepatogenic pulmonary angiodysplasia. Effects on pulmonary hemodynamics and gas exchange. 188 94

A patient had liver cirrhosis associated with marked hypoxemia. With administration of indomethacin (75 mg/day for six days), PaO2 was elevated up to 50 mm Hg from 44 mm Hg. At that time, dynamic pulmonary perfusion imaging revealed a plateau time course curve of MAA uptake in the lungs, as compared with findings obtained during the state of severe hypoxemia without indomethacin. These observations suggest that part of hepatogenic pulmonary angiodysplasia is a functional vasodilatation that is presumably modulated by vasoactive substances, such as prostaglandins and/or other eicosanoids.
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PMID:Effects of indomethacin on hepatogenic pulmonary angiodysplasia. 200 56

8 cases of gastrointestinal angiodysplasia are reported. It can be stated on the analysis of these cases, that the angiodysplasia can be the cause of unexplained GI hemorrhages, and in the majority of cases the visceral angiography provides diagnostic evidence. The angiodysplasia can be observed frequently in association with liver cirrhosis and aortic valvular stenosis. Surgery is regarded as the best method of treatment. Subsequently the careful resection rebleeding and development of newer angiodysplasia can occur.
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PMID:[Gastrointestinal angiodysplasia]. 221 20

Clinical and radiological findings of hepatogenic pulmonary angiodysplasia are reported in two cases. Myriad spidery pulmonary blood vessels are seen on plain radiographs and verified with right to left intrapulmonary shunting on pulmonary angiogram and pulmonary isotopic perfusion scan. Pathophysiology and differential diagnosis are discussed. We propose that the term "pulmonary angio-dysplasia" should include: 1) Pulmonary telangiectasia 2) Hereditary hemorrhagic telangiectasia (Osler-Rendu-Weber syndrome) 3) Classical discrete pulmonary arteriovenous fistula 4) Hepatogenic pulmonary angiodysplasia: pulmonary arteriovenous communications with right to left shunting secondary to hepatic cirrhosis.
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PMID:Plain radiographic, nuclear medicine and angiographic observations of hepatogenic pulmonary angiodysplasia. 622 68

Mucosal lesions of the digestive tract in cases of cirrhosis are described. The lesions include congestive gastropathy, antral vascular ectasia, erosions, brown macules and angiodysplasia in the stomach. Lesions are also observed in the duodenum and in the colon.
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PMID:Mucosal lesions of the digestive tract in cirrhosis. 836 41

Angiodysplasia is an important vascular lesion of the gut and a source of significant morbidity from bleeding. This lesion is probably responsible for approximately 6.0% of cases of lower gastrointestinal (GI) bleeding and 1.2-8.0% of cases of hemorrhage from the upper GI tract. Small bowel angiodysplasia accounts for 30-40% of cases of GI bleeding of obscure origin and represents the single most common cause for hemorrhage in this subset of patients. Lesions in the large bowel occur most often in the right colon. Their cause is unknown but most are probably acquired and the result of a degenerative process associated with aging. The incidence of colonic angiodysplasia among strictly asymptomatic individuals has never been determined and the natural history for these lesions is incompletely understood. Angiodysplasia in the upper GI tract occurs most often in the stomach and duodenum. When affected patients have been evaluated by colonoscopy concomitant lesions have been diagnosed in one-third of instances. Angiodysplasia has been purported to occur with higher frequency in patients with renal failure, von Willebrand's disease, aortic stenosis, cirrhosis, and pulmonary disease. Not all of these associations have been subjected to critical analysis, but available evidence does not support a strong relationship in most instances. Patients with bleeding angiodysplasia are occasionally treated with hormones or, more often, by endoscopic methods. Uncontrolled case studies have reported reduction or cessation of bleeding in subjects managed with conjugated estrogens. However, prospective randomized controlled trials assessing the efficacy of hormonal therapy are limited, and results from two trials conflict. Safety profiles for the endoscopic methods are acceptable, and reported efficacies are high, although not all methods have been extensively evaluated specifically for the treatment of angiodysplasia. Perforation of the right colon is a potential problem, especially for monopolar electrocoagulation and lasers.
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PMID:Angiodysplasia of the gastrointestinal tract. 825 4

Portal hypertensive gastropathy (PHG) and gastric antral vascular ectasia (GAVE) (watermelon stomach) are increasingly recognized as separate nosological entities detectable by careful upper gastrointestinal endoscopy and meticulous histological assessment. The have a significant phenomenological overlap; both usually present with gastric mucosal hemorrhage and have a striking association with cirrhosis. However, the distinct endoscopic and histological features, which are discussed in this paper, enable physicians to differentiate PHG from GAVE. Portal hypertension as the prerequisite of PHG necessitates surgical (portosystemic shunting) or medical (beta-blockade) portal decompressive therapy, whereas the angiodysplasia-like lesions in watermelon stomach are successfully treated by electrocoagulation or laser therapy.
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PMID:The stomach in cirrhosis. The legend of Proteus retold. 840 28

Forty one patients with bleeding vascular ectasias of the upper gastrointestinal tract who required blood transfusion were treated with endoscopic Nd:YAG laser photocoagulation and followed for 34 months (median). Four distinct groups of patients were identified. There was a sustained reduction in transfusion requirements after laser treatment in all those with single (nine patients) and multiple (seven patients) angiodysplasia, in 12 of 16 (75%) patients with watermelon stomachs, and in six of nine (66%) patients with hereditary haemorrhagic telangiectasia. Overall, 25 patients (61%) required minimal or no transfusion after treatment and nine (22%) whose bleeding was controlled initially, later developed recurrent bleeding which was controlled with further laser (total 34 of 41, 83%). Surgery succeeded in a further three patients (7%) in whom laser had failed (in one case possibly because of laser induced haemorrhage). Five more cases of possible laser induced haemorrhage resolved with conservative treatment. One patient sustained a treatment related perforation and died: one patient with cirrhosis died of encephalopathy within one month of starting laser treatment. In two patients transfusion requirements were unchanged despite laser. Nd:YAG laser is a safe and effective treatment for most patients with upper gastrointestinal angiodysplasia.
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PMID:Laser ablation of upper gastrointestinal vascular ectasias: long term results. 849 92

Eight cases of upper gastro-intestinal bleeding associated with liver cirrhosis are reported in this paper. Morphological studies revealed gastroduodenal ulceration with severe vascular changes in the mucosa and submucosa layer. Capillary dilatation was seen in the superficial region of the mucosa. Thick-walled and tortuous vessels similar to angiodysplasia were noted in the submucosa. The latter vessels were surrounded by scar-like connective tissue considerably thickening the gastric submucous layer. It is assumed that scar-like thickening of the submucous layer surrounding the tele-angiectatic vessels causes microcirculatory disorders thus giving rise to bleeding ulcers.
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PMID:Gastric vascular ectasia in cirrhosis. 849 16


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