questions 3

Zollinger-Ellison (ZE) Syndrome

Topic updated on 04/22/14 12:37pm

Snap Shot
  • A 42 year old male executive complains of upper abdominal pain. He says he is under considerable stress at work and smokes a pack of cigarettes every day. He has no history of SOB, swelling of the feet, chest pain, or allergies. Further history reveals that the pain is worse at night and often wakens him from sleep. It occurs between meals and is appeased by drinking milk and eating a bland diet. On one occasion he vomited blood. Testing reveals a basal acid output (BA)) of 60 mEq (normal is <5 mEq and a serum gastrin level of 1000 pg/ml (normal is <300 pg/ml)
  • Caused by a malignant islet cell tumor that secretes excessive amounts of gastrin
    • causes excessive secretion of acid
    • results in peptic ulcer disease
      • ulcers are in unusual positions, without H. pylori infection or NSAID use
  • Associated with MEN type I
  • Symptoms
    • similar to PUD, GERD 
    • diarrhea
      • acidity in the duodenum inactivates pancreatic enzymes
  • BAO:MAO ratio 
    • increased
  • Serology
    • increased insulin, glucagon, gastrin 
  • Medical
    • PPIs & chemotherapy
  • Surgical
    • surgical resection of the tumor


Qbank (3 Questions)

0) (M1.GI.19) A 31-year-old Caucasian male presents to his physician's complaining of heartburn and diarrhea for 2 months. He reports a history of tumors of the parathyroid and pituitary glands. Laboratory results show a serum gastrin level of 1600 pg/mL (normal 0-200 pg/mL) and an increased basal acid output to maximal acid output ratio (BAO/MAO). The findings on endoscopy are shown in Figure A along with multiple gastric ulcerations. Stomach pH is measured to be 1.1. What is the most likely diagnosis? Topic Review Topic
FIGURES: A          

1. Meneiere's disease
2. Menetrier's disease
3. Zollinger-Ellison syndrome
4. Autoimmune gastritis
5. Peptic ulcer disease

0) (M1.GI.25) A 41-year-old female complains of frequent diarrhea and abdominal pain between meals. Endoscopy reveals a duodenal ulcer distal to the duodenal bulb. CT scan of the abdomen demonstrates a pancreatic mass, and subsequent tissue biopsy of the pancreas reveals a malignant islet cell tumor. Which of the following hormones is likely to be markedly elevated in this patient: Topic Review Topic

1. Gastrin
2. Cholecystokinin
3. Secretin
4. Vasoactive intestinal peptide
5. Motilin

0) (M1.GI.174) A 45-year-old male patient with a history of recurrent nephrolithiasis and chronic lower back pain presents to the ER with severe, sudden-onset, upper abdominal pain. The patient is febrile, hypotensive, and tachycardic, and is rushed to the OR for exploratory laporotomy. Surgery reveals that the patient has a perforated gastric ulcer. Despite appropriate therapy, the patient expires, and subsequent autopsy reveals multiple ulcers in the stomach, duodenum, and jejunum. The patient had been complaining of abdominal pain and diarrhea for several months but had only been taking ibuprofen for his lower back pain for the past 3 weeks. What is the most likely cause of the patient's presentation? Topic Review Topic

1. A gastrin-secreting tumor of the pancreas
2. A vasoactive-intestinal-peptide (VIP) secreting tumor of the pancreas
3. Cytomegalovirus infection
4. H. pylori infection
5. Chronic NSAID use


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