Flashcards in 010715 stomach disorders 3 Deck (17):
1
causes of elevated acid secretion
most important cause: elevated gastrin
elevated vagal tone
elevated histamine
elevated parietal cell mass
paraneoplastic (non-gastrin-rare)
2
elevated gastrin values cannot be interpreted without
knowledge of pH
normally, gastrin increases due to reduced delivery of acid to antrum
3
Zollinger-Ellison syndrome
hypersecretion of gastric acid due to gastrin secreting neuroendocrine tumor
isolated gastrinoma (75%)
as component of multiple endocrine neoplasia I (25%)
4
what is diagnostic of Zollinger Ellison syndrome
over 1000 pg/ml of gastrin with low pH
5
in what does secretin stimulation result in gastrin increasing?
Zollinger Ellison
6
types of Zollinger Ellison syndrome
sporadic or MEN1
7
sporadic Zollinger Ellison
single gastrinoma typically in duodenum or pancreas
8
clinical manifestations of Zollinger Ellison
more severe ulcer disease (extends to distal duodenum and jejunum)
diarrhea
9
causes of gastrin mediated high acid secretion
Zollinger Ellison
H pylori (via reduced somatostatin)
antral G cell hyperplasia
gastric outlet obstruction
retained antrum (antrum is no longer in the path of acid leaving the stomach due to some disconnect-in gastric surgery--so the antrum gets high pH stuff and keeps producing acid b/c it fails to sense properly)
short bowel syndrome
renal failure (rare)
10
secretin provocative test is used for
diagnosing Zollinger Ellison gastrinoma
11
acute H pylori infection has what effect on acid secretion?
decreases acid secretion
12
consequences of low acid secretion
overall well tolerated with modern diet. impaired protein digestion
impaired absorption of Fe, Ca, B12
gastric bacterial overgrowth
small bowel bacterial overgrowth
impaired delivery of certain drugs
13
Schilling test of vitamin B12 deficiency
replace vit B12 parenterally
24 hr urine collection of radiolabelled Vit B12 orally
if low, repeat while giving IF
if still low repeat after empiric antibiotic tx for sm bowel bac overgrowth
if still low--points to pancreatic insufficiency or terminal ileal disease
14
conditions affecting acid secretion also affect
IF secretion
pepsin/lipase secretion
bicarbonate/mucous secretion
15
peptic ulcer
ulcer in stomach or duodenum
16
melena
black feces due to upper GI bleeding
17