The Intern At Work: Internal Medicine The GIST of it all!
Jan 11, 2026
Dive into the fascinating world of gastrointestinal stromal tumors (GISTs) and learn about their unique cell origins and genetic factors. Explore common locations for these tumors and the variety of symptoms they present. Discover crucial assessment techniques, red flags, and key laboratory tests for diagnosis. Understand the importance of multidisciplinary care and the nuances in treatment options, from surgical interventions to the use of imatinib for advanced cases. Finally, hear insights on mutation considerations and the potential for late recurrences.
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Cell Of Origin And Molecular Drivers
- GISTs arise from the intestinal pacemaker cells called interstitial cells of Cajal and are driven by tyrosine kinase mutations.
- Most have KIT or PDGFRA mutations that activate growth signaling and cause neoplastic transformation.
Location Dictates Presentation
- GISTs most commonly occur in the stomach (≈60%) and small bowel (≈30%) but can appear elsewhere in the GI tract.
- Presentations vary by location, including bleeding, early satiety, anemia, obstruction, or change in bowel habits.
Prioritize Stability And Targeted History
- Always assess stability first and rule out active bleeding, obstruction, rupture, or hemodynamic instability.
- Focus history on weight loss, GI bleeding, anemia symptoms, abdominal mass, and family history including Carney's triad.