GI Flashcards by Sydnie Bookman

the celiac trunk supplies which structures

stomach
gallbladder
proximal small bowel

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the superior mesenteric artery supplies which structures

lower duodenum to 2/3rds of transverse colon

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the inferior mesenteric artery supplies which structures

distal 1/3rd of transverse colon to rectum

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what are the two watershed zones of the GI tract

splenic flexure and rectosigmoid junction

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what is the Z-line

squamo-columnar junction in the esophagus (glandular and squamous mucosa)

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which condition produces a punched out lesion appearance in the esophagus

herpes

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which condition produces a velvety, salmon colored mucosa in the esophagus

Barrett’s esophagus

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where would you find esophageal adenocarcinoma caused by Barrett’s esophagus

at or just above the squamocolumnar junction

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what should you ink on an esophagus specimen

the adventitia because it’s a margin

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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

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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

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what is the most important criteria for staging esophageal cancers

depth of invasion

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where is peptic ulcer disease most common

antrum or EGJ

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what is the most common malignant tumor of the stomach

carcinoma

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signet-ring cell carcinoma causes what

linitus plastica (leather bottle appearance)

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where should the stomach be opened

along greater curvature

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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

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what is the most important criteria for staging stomach carcinoma

depth of invasion

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tumor involving the serosa of the stomach stages it to a what

pT4

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what is the most important criteria for staging a stomach GIST

containment within stomach

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what is a MALT considered

extra-nodal non-hodgkin lymphoma

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what is the CPT code for a subtotal/total resection of the stomach for something other than a tumor

88307

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what is the CPT code for a subtotal/total resection of the stomach for a tumor

88309

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what is a Meckel’s diverticulum

blind pouch on anti mesenteric side

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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

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