A 62-year-old man comes to the office due to a 2-month history of progressive exertional dyspnea and fatigue. The patient says, "I feel tired all the time and take frequent naps during the day." He consumes a balanced diet and does not use tobacco, alcohol, or illicit drugs. Physical examination shows mucosal pallor. Stool testing for occult blood is positive. Laboratory results are as follows: Colonoscopy reveals several small, flat, cherry-red lesions in the right colon but is otherwise normal. Esophagogastroduodenoscopy and capsule endoscopy are normal. The likely cause of this patient's anemia is most strongly associated with which of the following?

Question

A 62-year-old man comes to the office due to a 2-month history of progressive exertional dyspnea and fatigue.  The patient says, "I feel tired all the time and take frequent naps during the day."  He consumes a balanced diet and does not use tobacco, alcohol, or illicit drugs.  Physical examination shows mucosal pallor.  Stool testing for occult blood is positive.  Laboratory results are as follows:  Colonoscopy reveals several small, flat, cherry-red lesions in the right colon but is otherwise normal.  Esophagogastroduodenoscopy and capsule endoscopy are normal.  The likely cause of this patient's anemia is most strongly associated with which of the following?

Quizplus · Accepted Answer

Explanation: 11ec2b69_c155_d20e_8f63_df11490ac0dc_MD0005_00 Angiodysplasias (vascular ectasias or arteriovenous malformations) are vascular anomalies composed of multiple aberrant blood vessels located in the gastrointestinal (GI) tract. A frequent cause of occult GI bleeding, angiodysplasias are most common in patients age >60 and are often discovered incidentally on endoscopy, appearing as small, cherry-red lesions. The pathogenesis may be due to chronic occlusions of submucosal veins, resulting in vascular congestion and the formation of dysplastic arteriovenous collaterals. Only a small percentage of angiodysplasias bleed; however, bleeding rates are higher with end-stage renal disease (ESRD), aortic stenosis, and von Willebrand disease (vWD) as these conditions most likely cause a bleeding diathesis that leads to more frequent GI bleeding from malformed vessels. Uremia associated with ESRD causes platelet dysfunction, and both aortic stenosis (which leads to acquired vWD due to mechanical disruption during valvular flow) and hereditary vWD cause decreased levels of vW factor, which is required for platelet aggregation. (Choice A) Dermatomyositis, an inflammatory myopathy with a characteristic heliotrope rash and Gottron papules, is associated with multiple malignancies, including lung, colon, and ovarian cancers. This patient has evidence of a GI bleed and microcytic (mean corpuscular volume <80/μm³) anemia (likely due to iron deficiency), which are concerning for colon cancer; however, colonoscopy would likely reveal a protruding endoluminal neoplasm. heliotrope rash Gottron papules (Choices C and D) Primary sclerosing cholangitis causes scarring of the biliary ducts, eventually leading to cirrhosis; it is strongly associated with ulcerative colitis (UC). Seronegative spondyloarthropathy (eg, ankylosing spondylitis) can be seen with UC or Crohn disease. However, UC typically causes bloody diarrhea, tenesmus, and abdominal pain, and colonoscopy reveals characteristic colitis with inflammation and friable mucosa. Crohn disease typically causes prolonged diarrhea, abdominal pain, and weight loss, and colonoscopy reveals focal ulcerations alongside normal mucosa (cobblestone with skip lesions). (Choice E) Tricuspid valve regurgitation can be associated with carcinoid syndrome, which causes flushing and diarrhea but not bleeding. Educational objective: Angiodysplasias are frequent causes of gastrointestinal bleeding, particularly in patients with end-stage renal disease, von Willebrand disease, and aortic stenosis.

A 62-Year-Old Man Comes to the Office Due to a 2-Month