SG LI Flashcards
Ab pain + N
Stomach: ulcerating mass, partially necrotic
Histo: infiltrative process of the stomach wall + diffuse inflam of mucosa (lymphocytes)
- Cohesive glands in submucosa (shouldn’t be there)
Adenocarcinoma
- Intestinal type
Do you see masses with diffuse type adenocarcinoma?
No, diffuse thickening (doesn’t present as mass)
This also part of why these present so late
What is the most important prognostic factor for GI cancers?
Depth of invasion = dets T
Then N and M
Describe diffuse adenocarcinoma disease process
Single (signet) cells that produce mucin and move through the tissue - reactive process causes thickening
Risk factors for gastric adenocarcinoma
Familial history - Diffuse: e-cadherin mutation H.pylori Smoking, alcohol Nitrates
H/o IBD Crampy ab pain + diarrhea Imaging: active inflam + stricture SI resection: nodules, ulcerations Histo: granuloma, ulcers, inflam
Crohn’s = ulcers + granuloma in SI
What cell is in the granuloma
MACROPHAGES
What are crypt absesses?
Neutrophils in the crypt lumen
What is cryptitis?
Neutrophils attacking crypt lumen
What disease do crypt absesses and cryptitis indicate?
Active IBD
Why don’t you resect Crohn’s?
B/c will recur
Only remove if emergency
Is rectum involved in Crohn’s?
No
Where is inflam confined to in UC?
Mucosa only
Not as infiltrative of Crohn’s
What is a liver disease you might get if you have Crohn’s?
PSC
What can cure UC?
Resection!
Heart palpitations + crampy ab pain
5-HIAA in blood
Nodule in ileum + local mets -> nodules in mesentery
Liver mets
Hist: nested pattern, + neuroendocrine, salt and pepper nuclei
SI carcinoid
Why did that pt have heart palpitations and flushing?
Carcinod syndrome
Makes you think liver mets
Is SI or lung more likely to present with carcinoid syndrome?
SI
Is there such a thing as high grade carcinoid?
Probably but the point is that normal looking carcinoid can have high metastatic potential
Aka you know a carcinoid is bad not because of high grade but because of mets
Define adenoma in the bowel
At least low grade dysplasia
- No mucin
Post-menopausal female w/ Fe def anemia + solid food dysphagia
Plummer Vinson syndrome = esophageal web
Post-meno female w/ Fe def anemia alone
Think GI bleed
What is the next step after colon cancer resection surg for stage 3 cancer?
Adj 5-FU chemo
5FU SEs
Angina, hand-foot syndrome
