DR Medhat MRCP

Acute Intestinal ischemia
• Def :
- Poor blood supply to the intestine due to mesenteric vascular occlusion leading to
infarction & gangrene if acute & prolonged.
- Most common site is splenic flexure of the colon which is `watershed` between areas
supplied by superior & inferior mesenteric arteries.
- The caecum & terminal ilium are also commonly involved.
• Risk factors :
1. Old age.
2. Male sex.
3. Family history.
4. DM , HTN,DLP, SMOOKING.
5. Vasculitis.
6. Atrial fibrillation.
• Clinical presentation :
1. Severe/recurrent abdominal pain mainly after meals.
2. Bloody diarrhea/constipation
3. Hypotension & metabolic (lactic) acidosis.
4. Sluggish or non-audible bowel sounds.
• Investigations :
1. Abdominal CT angiography : test of choice.
2. High S.lactate levels.
3. Colonoscopy : carries high risk of perforation.
• Treatment :
Emergency surgery : bowel resection.
• Prognosis : high mortality rate.
سؤال امتحان Peutz-Jeghers syndrome
- Is an autosomal dominant condition characterised by
Numerous hamartomatous polyps in the GIT.
Pigmented freckles on the lips, face, palms and soles.
Around 50% of patients will have died from a GIT cancer by the age of 60
years.
• Genetics :
سؤال امتحان - Autosomal dominant
- Responsible gene encodes serine threonine kinase LKB1 or STK11.
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