GI Flashcards
the celiac trunk supplies which structures
stomach
gallbladder
proximal small bowel
the superior mesenteric artery supplies which structures
lower duodenum to 2/3rds of transverse colon
the inferior mesenteric artery supplies which structures
distal 1/3rd of transverse colon to rectum
what are the two watershed zones of the GI tract
splenic flexure and rectosigmoid junction
what is the Z-line
squamo-columnar junction in the esophagus (glandular and squamous mucosa)
which condition produces a punched out lesion appearance in the esophagus
herpes
which condition produces a velvety, salmon colored mucosa in the esophagus
Barrett’s esophagus
where would you find esophageal adenocarcinoma caused by Barrett’s esophagus
at or just above the squamocolumnar junction
what should you ink on an esophagus specimen
the adventitia because it’s a margin
what is the criteria to differentiate a stomach tumor vs an esophageal tumor
epicenter of tumor must be less than or equal to two cm from the EGJ on the stomach side
which sections should you take for an esophageal specimen
proximal margin
distal margin
lesion (deepest level of invasion)
lesion to normal
Z-line
Barrett’s if present
lymph nodes if present
what is the most important criteria for staging esophageal cancers
depth of invasion
where is peptic ulcer disease most common
antrum or EGJ
what is the most common malignant tumor of the stomach
carcinoma
signet-ring cell carcinoma causes what
linitus plastica (leather bottle appearance)
where should the stomach be opened
along greater curvature
which sections should you submit for a stomach
proximal margin
distal margin
mass (deepest level of invasion)
mass to normal
ulcers if present
normal
lymph nodes if present
what is the most important criteria for staging stomach carcinoma
depth of invasion
tumor involving the serosa of the stomach stages it to a what
pT4
what is the most important criteria for staging a stomach GIST
containment within stomach
what is a MALT considered
extra-nodal non-hodgkin lymphoma
what is the CPT code for a subtotal/total resection of the stomach for something other than a tumor
88307
what is the CPT code for a subtotal/total resection of the stomach for a tumor
88309
what is a Meckel’s diverticulum
blind pouch on anti mesenteric side
where are peptic ulcers most common
duodenum
50% of Meckel’s diverticulum have what on cut section
ectopic gastric mucosa or pancreatic parenchyma
where is the most common location for bowel ischemia
splenic flexure watershed zone
what is the most common cause for ischemic bowel
arterial thrombus or embolus
what sections should you take for an ischemic bowel
resection margins
transitional mucosa
vessels with blood clots if present
representative lymph nodes
what is the most common location of a carcinoid in the GI tract
ileum/appendix
majority of adenocarcinoma cases of the GI tract occur where
duodenum
NET make up ____ % of small bowel tumors
50%
what is the most important criteria for staging small bowel cancer
depth of invasion
how many lymph nodes must be submitted for a small bowel case
at least 12 but preferably all
what are three key elements found in the large intestine but not the small intestine
appendices epiploicae
tinea coli
haustra
what is Hirschsprung disease
absence of ganglion cells and ganglia within muscle wall and submucosa
pseudomembranous colitis is caused by what
C. difficile infection
who, females or males, are most affected by Hirschsprung disease
males (4:1)
how should you orient Hirschsprung biopsies
perpendicular to the rectal wall
should you do a lymph node dissection for a diverticulitis case
no
what is an important anatomic landmark for colon specimens
ICV
if a lesion is above the anterior serosal reflection, what is the term used
radial
if the lesion is below the anterior serosal reflection, what is the term used
circumferential
what is the difference between a high anterior resection and a low anterior resection
high: cut above the anterior serosal reflection (no mesorectal tissue)
low: cut below the anterior serosal reflection (mesorectal tissue shows)
what is the most common cause of toxic megacolon
anti-biotic related pseudomembranous colitis
what is a pertinent negative in toxic megacolon cases
perforation
what is the cause of pseudomembranous colitis
C. diff
define hematochezia
passage of fresh blood through the anus
define melena
dark stool with particularly digested blood
what is important to note for a diverticulosis case
presence of exudate and hemorrhage which indicates a perforation
what is an important pertinent negative for a diverticulosis case
presence or absence of any gross lesions
what is a distinctive feature of ulcerative colitis
disease occurs towards the distal end of colon
what are three distinctive features of Crohn’s disease
cobblestone appearance
thickening of the wall
skip lesions
which condition, ulcerative colitis or Crohn’s, poses threat of progression on to cancer
ulcerative colitis
what is the rule of thumb for submitting representative sections in Crohn’s and ulcerative colitis cases
one section per 10 cm
what is important to note for ruling out cases of familial polyposis
number of polyps - must be 100 or more to be considered familial polyposis
if >100, use “innumerable”
what is important to submit in a case of familial polyposis
large polyps - do not shave off leave them intact
how should you open a colon
along the anti-mesenteric boarder unless there is a tumor
what is the dentate line
transition between columnar and squamous epithelium in the anus
what is another name for the circumferential radial margin
mesorectal margin
what is important to note in an anal/rectal specimen
whether the resection is complete (grade 3 - bulky), nearly complete (grade 2 - less bulk), or incomplete (grade 1 - visible muscle)
what is important to note about the tumor location in regards to anal/rectal specimens
how close the tumor is in regards to the margins as well as to the peritoneal reflection and dentate line
which staging system is used for anal/rectal malignancies
TNM - based on depth of invasion
what is the most important factor in staging anal malignancies
tumor size
which device is used to give proximal and distal donuts of colon resections
anvil devise
