three separate determinations

Discussion in 'MRCS Forum' started by Shahid., Apr 24, 2008.

  1. Shahid.

    Shahid. Guest

    A 30-year-old man with a duodenal ulcer is being considered for surgery because of intractable pain and a previous bleeding episode. Serum Gastrin levels are found to be over 1000 pg/ml (normal is 40 to 150) on three separate determinations. The patient should be told that the operation of choice is -

    a- Vagotomy and pyloroplasty
    b- Highly selective vagotomy and tumor resection
    c- Subtotal gastrectomy
    d- Total gastrectomy
    e- Partial pancreatectomy
  2. Shahid.

    Shahid. Guest

    Answer: b. (Greenfield, 2/e, pp 919-925) total gastrectomy was formerly the procedure of choice for patients with Zollinger-Ellison syndromes (ZES). However, with the knowledge that most patients will die of metastatic disease and that the symptoms can often be controlled with H2 receptor antagonists, the role for surgery has changed. Initial surgical exploration is aimed at curative resection of the tumor. Unfortunately, metastatic disease is often present or will develop at a later date despite tumor resection. Therefore, highly selective vagotomy is also added to the procedure to reduce the required does of H2 receptor antagonists.

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