A 40-year-old man who has a long history of peptic ulcer dis

Discussion in 'MRCS Forum' started by Ketty., Mar 11, 2008.

  1. Ketty.

    Ketty. Guest

    A 40-year-old man who has a long history of peptic ulcer disease that has not responded to medical therapy is admitted to the hospital. His serum Gastrin levels are markedly elevated; at celiotomy, a small, firm mass is palpated in the tail of the pancreas. Correct statements concerning this patient’s condition include which of the following?
    a- Histamine or a protein meal will markedly increase basal acid secretion
    b- Secretion administration will suppress acid secretion
    c- The pancreatic mass will suppress probably be benign
    d- Distal pancreatectomy is the treatment of choice
    e- H2 receptor antagonists have not been beneficial in the treatment of this condition
  2. Ketty.

    Ketty. Guest

    The correct Answer is : d.

    Explanation : (Schwartz, 7/e, pp 1190-1196) the syndrome of a Gastrin-secreting non-beta cell pancreatic tumor is a rare entity first described by Zollinger and Ellison. They originally described a triad of (1) fulminant, complicated peptic ulceration; (2) extreme gastric hyper-secretion; and (3) a non-beta cell tumor of pancreatic islets. Over 50% of the tumors are malignant, and 40% have metastases at the time of surgery. Until recently, total Gastrectomy was the primary operation for this tumor; however, it is now believed that operative exploration of the patient with resection of the tumor should be done if possible. H2 receptor antagonists have also proved very promising in the management of these patients. Patients with Zollinger-Ellison tumors have very high basal levels of gastric acid (greater than 35 meq/h) and serum Gastrin (usually greater than 200 pg/ml). A protein meal or histamine usually does not increase acid and Gastrin levels as it would in conventional duodenal ulcer patients. A paradoxical rise in serum Gastrin after intravenous secretion is diagnostic of Zollinger-Ellison syndrome.

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