Git journal club Gastrointestinal ischemic injuries GI3: GIT Vascular emergencies

1. Prepared by:
Dr. Mohamed Al-Shekhani.
Kurdistan Board GEH Journal club.

2. MOST OFTEN MISUNDERSTOOD BY
GASTROENTEROLOGISTS .
MAY OCCUR WITH OR WITHOUT DIGESTIVE
VASCULAR OCCLUSION.
WHATEVER THE MECHANISMS THE
INCIDENCE IS INCREASING
THE PROGNOSIS COULD BE IMPROVED BY
AN INNOVATIVE MULTIMODAL &
MULTIDISCIPLINARY MANAGEMENT
INITIATED AT EARLY PRESENTATION.

3. DIAGNOSIS MUST BE SUSPECTED WITH ANY
SUDDEN, CONTINUOUS & UNUSUAL
ABDOMINAL PAIN, CONTRASTING WITH
NORMAL PHYSICAL EXAM INITIALY.
THROMBO-ATHERO-EMBOLIC RISK FACTORS
ARE OFTEN UNKNOWN AT PRESENTATION & NO
BIOCHEMICAL TEST IS SPECIFIC.
ABSENCE OF INDIVIDUAL RISK FACTORS OR
NORMAL BIOLOGY MIGHT NOT DENY OR
DELAY THE DIAGNOSIS, WHICH SHOULD BE
CONFIRMED BY ABDOMINAL CT ANGIOGRAPHY
IDENTIFYING GASTRO-INTESTINAL ISCHAEMIC
INJURY, WITH OR WITHOUT VASCULAR
OCCLUSION.

4. GASTROENTEROLOGISTS
HAVE A MAJOR ROLE IN THE MANAGEMENT, TO
AVOID DEATH & LARGE INTESTINAL RESECTIONS,
BY INITIATING & COORDINATING A
MULTIDISCIPLINARY A/MULTIMODAL
MANAGEMENT INCORPORATING A MEDICAL
PROTOCOL, REVASCULARIZATION OF VIABLE
DIGESTIVE SEGMENTS&RESECTION OF NON-
VIABLE INTESTINE.
THERAPEUTIC STRATEGY DEPENDS ON THE
PRESENCE OF AT LEAST ONE OF THREE CRITERIA
(NECROSIS, ORGAN FAILURE, OR
ELEVATED SERUM LACTATE).

5. IN THE EARLY STAGES, PATIENTS WITHOUT
SURGICAL COMPLICATION, ORGAN FAILURE OR
HIGH LACTATE LEVELS SHOULD BE TREATED
MEDICALLY WITH ENDOVASCULAR
REVASCULARIZATION WHENEVER POSSIBLE.

6. AT LATER STAGES, SURGICAL MANAGEMENT
REQUIRES BOTH RESECTION &
REVASCULARIZATION.
ANY FACTOR THAT MAY HAVE CONTRIBUTED TO
THIS ISCHAEMIC STROKE (I.E
ATHEROSCLEROSIS, CARDIAC EMBOLISM OR
THROMBOPHILIA)
SHOULD BE INVESTIGATED &TREATED, WITH
PARTICULAR REFERENCE TO ISCHAEMIC COLITIS
& NON-OCCLUSIVE MESENTERIC ISCHEMIA.

19. What’s Your Message?THANKS