Dr. Lotus Alphonsus

For example, a gastric gist often presents with bleeding due to ulceration, early satiety, and abdominal discomfort.

Small bowel gists can present with melina, anemia, or obstruction.

On the other hand, rectal GISTs often present with rectal bleeding and change in bowel habits.

The first step when assessing your patient is to assess stability as always.

Ask yourself, is there active bleeding?

Are there signs of obstruction?

Is the patient hemodynamically stable?

If a patient with GIST presents with new abdominal pain, you want to rule out a rupture, bleeding, or progression before assuming benign causes.

When it comes to taking a history and physical exam, these are the key points that you should be focusing on.

Ask about weight loss, GI bleeding, and abdominal pain.

You should assess for signs of anemia, such as fatigue, weakness, shortness of breath, pallor, and abdominal masses, like feeling of fullness, change in bowel habits, and abdominal pain.

remember to ask for a family history of cancers or malignant syndromes.

As a reminder, Carney's triad is a rare syndrome characterized by the presence of at least two of three specific tumors, just extra adrenal paraganglioma and or pulmonary chondromas.

Other important diagnoses to consider on the differential list for GIST includes adenocarcinoma, lymphoma, leiomyoma, and neuroendocrine tumors and GI meds.

In terms of workup for GIST for blood work, you want to check the CBC, specifically looking for anemia, of course.

You also need to think beyond colon cancer for asymptomatic iron deficiency anemia in older adults.

GIST can be the leading culprit, especially in the jejunum and ileum, where there are blind spots for standard scopes.

You should also order iron studies and liver enzymes and function tests, especially if you suspect metastatic disease.

In terms of imaging, the gold standard for localization and staging is a CT abdomen pelvis with contrast.

Other imaging modalities can also help.