Related disorders to PUD

Question 1

Severe peptic ulcer diathesis secondary to gastric acid hypersecretion due to unregulated gastrin release from a non-β cell often well-differentiated neuroendocrine tumor (gastrinoma)

Answer 1

ZES

Question 2

driving force responsible for the clinical manifestations in ZES

Answer 2

Hypergastrinemia originating from an autonomous neoplasm

Question 3

Over 80% of gastrinomas are found within the hypothetical gastrinoma triangle…

Answer 3

confluence of the
* cystic and common bile ducts superiorly
* junction of the second and third portions of the duodenum inferiorly
* and junction of the neck and body of the pancreas medially

Question 4

the most common clinical manifestation in ZES
vs the 2nd most common

Answer 4

1. Peptic ulcer
2. Diarrhea

Question 5

Duodenal tumors constitute the most common nonpancreatic lesion in ZES. True or False

Answer 5

True

Question 6

Gastrinomas can develop in the presence of tihs endocrine syndrome

Answer 6

MEN 1

Question 7

The first step in the evaluation of a patient suspected of having ZES is

Answer 7

to obtain a fasting gastrin level

Question 8

When to exclude ZES in the diffentials using fasting gastrin

Answer 8

A normal fasting gastrin, on two separate occasions, especially if the patient is on a PPI, virtually excludes this diagnosis.

Question 8

The effect of the PPI on gastrin levels and acid secretion will linger several days after stopping the PPI; therefore, it should be stopped for a minimum of ____days before testing.

Answer 8

seven

Question 9

histamine H2 antagonist, such as famotidine needs to be stopped ____ days before testing for gastrin level

Answer 9

1 day

Question 10

The next step at times needed for establishing a biochemical diagnosis of gastrinoma is to assess WHAT

Answer 10

acid secretion

first step is to assess gastrin secretion

Question 14

a pH ____ is suggestive of a gastrinoma,

Answer 14

less than 3

Question 15

A BAO ________meq/h in the presence of hypergastrinemia is considered pathognomonic of ZES,

Answer 15

A BAO more than 15 meq/h in the presence of hypergastrinemia is considered pathognomonic of ZES,

Question 16

most sensitive and specific gastrin provocative test for the diagnosis of gastrinoma is __________

Answer 16

the secretin study

Question 17

PPI-induced hypochlorhydria or achlorhydria may lead to a false-positive secretin test

Answer 17

Why is PPI stopped 1 week prior to secretin test

Question 18

Once a biochemical diagnosis has been confirmed in ZES, the patient should first undergo …. to exclude metastatic disease

Answer 18

• an abdominal computed tomography (CT) scan
• magnetic resonance imaging (MRI)
• OctreoScan/PET-CT with68 Ga-DOTATATE (depending on availability

Question 19

treatment of choice for ZES

Answer 19

PPI

Question 20

Favorable prognostic indicators in ZES

Answer 20

• primary duodenal wall tumors
• isolated lymph node tumor
• the presence of MEN 1,
• and undetectable tumor upon surgical exploration

Question 21

The most common causes of acute gastritis are

Answer 21

infectious ( H pylori)

Question 22

Chronic atrophic gastritis
Type A vs Type B

Answer 22

Chronic atrophic gastritis
A. Type A: Autoimmune, body-predominant
B. Type B: H. pylori–related, antral-predominant

Question 23

stages of chronic gastritis (3)

Answer 23

Question 24

denotes the conversion of gastric glands to a small intestinal phenotype with small-bowel mucosal glands containing goblet cells.

Answer 24

intestinal metaplasia

Question 25

which is less common… Type A or Type B gastritis

Answer 25

Type A

Question 26

Traditionally, this form of gastritis has been associated with pernicious anemia

Answer 26

Type A

Question 27

Treatment for pernicious anemia

Answer 27

long term parenteral vitamin B supplementation

Question 28

________ is characterized histologically by intense infiltration of the surface epithelium with lymphocytes. The infiltrative process is primarily in the body of the stomach and consists of mature T cells and plasmacytes.

Answer 28

Lymphocytic gastritis

Question 29

A subgroup of patients with lymphocytic gastritis have thickened folds noted on endoscopy. These folds are often capped by small nodules that contain a central depression or erosion; this form of the disease is called ____

Answer 29

varioliform gastritis

Question 30

eosinophilic gastritis, what layers of the stomach are involved

Answer 30

any layer of the stomach (mucosa, muscularis propria, and serosa)

Question 31

Term for a mucosal lesion of unknown etiology that has a pseudotumoral endoscopic appearance.

Answer 31

Russell body gastritis (RBG)

Question 32

Histologically, it is defined by the presence of numerous plasma cells containing Russell bodies (RBs) that express kappa and lambda light chains.

Answer 32

Russell body gastritis (RBG)

Question 33

a very rare gastropathy characterized by large, tortuous mucosal folds.

Answer 33

Ménétrier’s disease (MD)

Question 34

mucosal folds in MD are often most prominent in the what part of the stomach

Answer 34

body and fundus, sparing the antrum.

Question 35

Histologically, massive foveolar hyperplasia (hyperplasia of surface and glandular mucous cells) and a marked reduction in oxyntic glands and parietal cells and chief cells are noted.

Answer 35

Menetrier’s disease

Question 36

etiology of Menetrier’s disease in children vs adults

Answer 36

The etiology of this unusual clinical picture in children is often CMV, but the etiology in adults is unknown.

Question 37

How to diagnose Menetrier’s disease

Answer 37

Endoscopy with deep mucosal biopsy, preferably full thickness with a snare technique

Question 37

Drug that can cause near complete histologic remission in Menetrier’s disease

Answer 37

Cetuximab

Question 38

First line treatment for Menetrier’s disease

Answer 38

Cetuximab

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