SG LI

Question 1

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)

Answer 1

Adenocarcinoma

- Intestinal type

Question 2

Do you see masses with diffuse type adenocarcinoma?

Answer 2

No, diffuse thickening (doesn’t present as mass)

This also part of why these present so late

Question 3

What is the most important prognostic factor for GI cancers?

Answer 3

Depth of invasion = dets T

Then N and M

Question 4

Describe diffuse adenocarcinoma disease process

Answer 4

Single (signet) cells that produce mucin and move through the tissue - reactive process causes thickening

Question 5

Risk factors for gastric adenocarcinoma

Answer 5

Familial history 
- Diffuse: e-cadherin mutation 
H.pylori 
Smoking, alcohol 
Nitrates

Question 6

H/o IBD
Crampy ab pain + diarrhea 
Imaging: active inflam + stricture
SI resection: nodules, ulcerations
Histo: granuloma, ulcers, inflam

Answer 6

Crohn’s = ulcers + granuloma in SI

Question 7

What cell is in the granuloma

Answer 7

MACROPHAGES

Question 8

What are crypt absesses?

Answer 8

Neutrophils in the crypt lumen

Question 9

What is cryptitis?

Answer 9

Neutrophils attacking crypt lumen

Question 10

What disease do crypt absesses and cryptitis indicate?

Answer 10

Active IBD

Question 11

Why don’t you resect Crohn’s?

Answer 11

B/c will recur

Only remove if emergency

Question 12

Is rectum involved in Crohn’s?

Answer 12

No

Question 13

Where is inflam confined to in UC?

Answer 13

Mucosa only

Not as infiltrative of Crohn’s

Question 14

What is a liver disease you might get if you have Crohn’s?

Answer 14

PSC

Question 15

What can cure UC?

Answer 15

Resection!

Question 16

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

Answer 16

SI carcinoid

Question 17

Why did that pt have heart palpitations and flushing?

Answer 17

Carcinod syndrome

Makes you think liver mets

Question 18

Is SI or lung more likely to present with carcinoid syndrome?

Answer 18

SI

Question 19

Is there such a thing as high grade carcinoid?

Answer 19

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

Question 20

Define adenoma in the bowel

Answer 20

At least low grade dysplasia

- No mucin

Question 21

Post-menopausal female w/ Fe def anemia + solid food dysphagia

Answer 21

Plummer Vinson syndrome = esophageal web

Question 22

Post-meno female w/ Fe def anemia alone

Answer 22

Think GI bleed

Question 23

What is the next step after colon cancer resection surg for stage 3 cancer?

Answer 23

Adj 5-FU chemo

Question 24

5FU SEs

Answer 24

Angina, hand-foot syndrome

Question 25

Oxaliplatin SE

Answer 25

Peripheral neuropathy

Question 26

Treat stage 4 colo-rectal cancer

Answer 26

Systemic chemo

Question 27

What type of cancers do you use anti-EGFR therapy in?

Answer 27

K-ras +

Question 28

Do you remove low grade rectal cancer?

Answer 28

NO - pevlic cancer is hard surgery

Do chemo/radiation first esp to save the anal sphincter

Question 29

Treat gastric cancer

Answer 29

Surg then chemo radiation