010715 stomach disorders 3 Flashcards Preview

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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

biopsy of stomach can look for (in the context of ulcers)

H pylori