xxxxx 35. Neuroendocrine tumors of GIT or pancreaxxx Flashcards Preview

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Flashcards in xxxxx 35. Neuroendocrine tumors of GIT or pancreaxxx Deck (16)
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1
Q

neuroendocrine tumors of the gatsroinetsinal tract are mainly caused where ?

A

50 percent in the appendix vermiformis
then rectim
then ileum
jejunum

2
Q

what so the neuroendocrine cells in the GIT release and what are the controlled by ?

A

somatostins made in the hypothalamus and gastroinetsinal tract = inhibting these neuroendocrine cells to release these hormones

hormones such as serotonins and histamine

bradykinin - vasodilator

prostaglandins

3
Q

what are the signs and symtpoms of GIT carcinoids ?

A

carcinoid syndrome

flush and tachycardia and blood pressure fluctioations

diarrhea and colic like abdominal pain

asthma attack - serotonin causes bronchoconstrction

hedinger syndrome - right sided endocardiial fibrosis , with tricuspid insuffiency and pulmonary valve stenosis

4
Q

how can we diagnose carcinoid tumors ?

A

increase 5 - hydroxy indol eacetic acid - ( degredation from the liver from serotonin) = 24 hr urine

increase serotonin in serum

chormagen A in serum increase

EUS
CT
MRI
somatostatin receptor scintography

5
Q

what is the most common place for carcinoid tumors to metastsise to ?

A

liver - we find out metastasis to the liver is necessary for the CARCINOID SYNDROME TO OCCUR = liver dysfunction = less metabolsim of hormones such as serotonicn = so its effects comes about

6
Q

symtpoms of gastroinetsinal carcinoid tumors can be worsened by ?

A

alcohol and emotional stress

7
Q

what are the treatmnet for gastrointestinal carcinoid tumors ?

A

surgical resection

somatostatin analgoues
radiotherapy with radioactive somatostatin analogues
palliative chemotherapy

8
Q

what are the two main neuroendocinr tumors of the pancreas ?

A
inuslinoma (mostly benign) 
and gastrinoma (mostly malignant)   = zollinger ellison sydrome
9
Q

what is the cause of zollinger ellison syndrome ?

A

occurs sporadically = 75 percent

or the rest by mutation of multiple endocrine neoplasia type 1

10
Q

what are the symptos of zollinger ellison syndrome ?

A

peptic ulcers
inactivation of lipases by increasing the gastric acidity = diarrhea and steatorrhea
alnutrition

11
Q

what is the diagnpsis of zollinger ellison syndrome ?

A

fasting gastrin levels on 3 seperate occasons
increased gastrin above 1000ng/l

secretin stimulation test = evoked gastrin levels (normal physiology secretin inhibits neuroendocrine cells hoever in gastrinoma cells it evokes it )

increased chromogranin a = tumor marker for carcinoid tumors

endoscopy of peptic ulcer , gastric ph decreased

CT scan

MRI

somatostatin receotor scintography

12
Q

what is the treatment for zollinger ellison syndrome ?

A

curative tumor resection possible,
if there are no metastases
reduction of acid production: proton pump inhibitors
chemotherapy in metastasis

13
Q

describe the charachteristics of insulinoma ?

A

benign with a diameter <2cm

larger insulinomas are most likely
malignant

mostly solitary

14
Q

what are the symptoms for insulinoma ?

A

neuroglycopenic symptoms :
recurrent headache,
diplopia,
blurred vision particularly with exercise or fasting.

Severe hypoglycemia :
seizures,
coma,
and permanent neurological damage.

Symptoms resulting from the catecholaminergic response to hypoglycemia 
shaking , 
palpitations,
 tachycardia, 
sweating, 
hunger, 
anxiety,
15
Q

what is the diagnosis of inulinoma ?

A

concomitant plasma glucose level of 45 mg/dL (2.5 mmol/L) or less, and

reversibility of symptoms with administration of glucose

serum glucose , insulin and c-peptide

A 72-hour fast, usually supervised in a hospital setting, can be done to see if insulin levels fail to suppress, which is a strong indicator of the presence of an insulin-secreting tumor.

----------
endoscopic US 
ultraosund 
CT scan 
MRI
16
Q

what is the treatment of insulinoma ?

A

surgical resection of the insulinoma = can be with whipple procedure or sital pancreatectomy

diozoxide and somatostatin analogues = block release of insulin

chemotherapy of
streptozotocin = for insulinomas and 5-fu