Gastroenterology: Gastrinoma and B12 Deficiency

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Questions and Answers

What is the primary consequence of gastrin-stimulated acid secretion in Zollinger-Ellison Syndrome?

Direct mucosal damage by acid (correct)

Increased pancreatic enzyme activity

Increased bile salt precipitation

Enhanced gastrointestinal motility

Which of the following is a diagnostic criterion for Zollinger-Ellison Syndrome?

Fasting serum gastrin levels < 1 ng/L

Basal acid output (BAO) > 15 mEg/h (correct)

Basal acid output (BAO) < 5 mEg/h

Gastric pH > 2.0

What is a common complication of Zollinger-Ellison Syndrome?

Gastric carcinoids

Esophageal stricture with reflux

Abdominal perforation secondary to ulceration

All of the above (correct)

What is the primary mechanism by which botulinum toxin (Botox) can aid in the treatment of achalasia?

By blocking the release of acetylcholine from nerve terminals Signup and view all the answers

Which of the following hormones increases acid production in the stomach?

Gastrin Signup and view all the answers

What is the primary treatment goal for Zollinger-Ellison Syndrome?

Medical control of gastric acid hypersecretion Signup and view all the answers

What is the name of the surgical procedure used to treat hiatal hernias?

Nissen fundoplication Signup and view all the answers

What is a characteristic symptom of Zollinger-Ellison Syndrome?

Abdominal pain in the upper abdomen Signup and view all the answers

What is the term for the metaplasia of the distal esophagus, which is associated with an increased risk of adenocarcinoma?

Barrett's esophagus Signup and view all the answers

What is the name of the diagnostic test used to measure the amount of acid reflux into the esophagus?

pH monitoring examination Signup and view all the answers

What is the consequence of decreased dietary fiber in relation to feces propulsion?

Difficulty in forward propulsion of feces at normal transmural pressures Signup and view all the answers

What percentage of patients with diverticulosis develop acute diverticulitis?

5% Signup and view all the answers

What is the typical location of abdominal pain in acute diverticulitis?

Left lower abdominal quadrant Signup and view all the answers

What is the outcome of acute diverticulitis in the majority of cases?

Stops spontaneously Signup and view all the answers

What is the approximate percentage of patients who develop diverticulitis and require surgery?

15-25% Signup and view all the answers

Study Notes

Zollinger-Ellison Syndrome (ZES)

Caused by gastrin-secreting tumor (gastrinoma)
Stimulates the acid-secreting cells of the stomach to maximal activity
Hyperproliferation of gastric glands and parietal cells
Excess secretion of gastric acid
Associated with MEN I (Multiple Endocrine Neoplasia type I) in 25% of cases
Primary tumor locations: duodenum, pancreas, abdominal lymph nodes
Ectopic locations: heart, ovary, gallbladder, liver, kidney
Symptoms:
- Hypergastrinemia
- Gastritis symptoms
- Abdominal pain
- Diarrhea
- Malabsorption
- Weight loss
- Nausea, vomiting, GI bleeding
Physical examination: may reveal paleness, epigastric tenderness, hepatomegaly
Diagnosis: fasting serum gastrin, gastric acid secretory tests
Complications: abdominal perforation, esophageal stricture, obstruction, GI bleeding, gastric carcinoids
Prognosis: excellent in patients without metastatic disease
Goals of treatment: medical control of gastric acid hypersecretion, surgical resection of tumor, chemotherapy, liver transplantation

Hyperbilirubinemia

No specific information provided in the text

Diverticulosis

Decreased dietary fiber contributes to development of diverticulosis
Clinical manifestation: abdominal pain, constipation, diarrhea, flatulence
Acute diverticulitis: affects 5% of patients with diverticulosis, symptoms mimic acute appendicitis
Complications: abscess, perforation, fistula formation, intestinal obstruction
Diverticular bleeding: painless, typically occurs in the elderly, associated with diverticulosis

Esophageal Achalasia

Motor disorder characterized by failure of LES to relax properly
Symptoms: dysphagia, regurgitation, chest pain, weight loss, mucosal ulceration
Etiology: degeneration of myenteric plexus, loss of inhibitory enteric neurons
Diagnosis: esophageal manometry, contrast esophagram, esophagoscopy
Treatment: reduce pressure at the lower esophageal sphincter, medications, injection with botulinum toxin, widening of the esophagus, surgery

Reflux Esophagitis (GERD)

Chronic symptoms or mucosal damage produced by abnormal reflux in the esophagus
Due to: incompetence of the LES, transient LES relaxation, impaired expulsion of gastric reflux, hiatus hernia
Clinical presentation: heartburn, dysphagia, hemorrhage, perforation, hoarseness, coughing, wheezing, aspiration pneumonia
Diagnosis: barium swallow radiograph, upper endoscopy, pH monitoring examination
Treatment: drugs (antacids, H2 blockers, proton pump inhibitors, prokinetics), surgery (fundoplication)

Acid-Peptic Disease (APD)

Disorder of GIT resulting from imbalance between protective and aggressive factors
Different forms of APD: duodenal ulcer, gastric ulcer, gastritis
Etiology: Helicobacter pylori, predisposition to several forms of APD

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Description

This quiz covers the effects of B12 deficiency on purine and thymine synthesis, as well as the characteristics of gastrin-secreting tumors, including Zollinger-Ellison Syndrome and its symptoms.