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75 year old woman with lower GI bleed

Angiodysplasia

• Image findings: Intralumenal hemorrhage along with early and prominent filling of the accompanying mesenteric vein
• Angiodysplasia is a vascular abnormality that is a common cause of lower GI bleeding in those over age 50
• The lesions are generally founfd in the right colon, espicially the cecum
• They are common, found in 2% of autopsies
• Radiographic Features: Vascular tuft on antimesenteric border. Early or persistent draining vein. Active bleeding usually cannon be seen
• Treatment: Because of the abnormal vessels, bleeding from angiodysplasia is typically not responsive to Vasopressin infusion (can be considered). Surgical resection is curative. Do not embolize.

Vasopressin (per Dr. Venbrux)

• Vasopressin is a vasoconstrictor
• Mix 100 units in 500 cc of Saline. This give a concentration of 0.2 units/cc
• Humans can tolerate 0.2 units/minute. Can give 60 cc/hour (12 units/hour)
• Typically administration regimen: give Vasopressin for 20 minutes then reimage to evaluate bleeding. If still extravasating then increase dosage to 0.4 units per minute
• Whether infusing 0.2 units/minute or 0.4 units, administer medication and taper over a 24 hour period. Patient should be in the ICU
• Complications of Vasopressin: HTN, CVA, Angina, gut infraction, digital ischemia, metabolic disturbances (decreased sodium), groin complications (as line in place 24 hours) e.g, hematoma, pseudoaneurysm.