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.. Recurrent Gastric Ulcers .. 4 new 4th year Hakeems..


.. Recurrent Gastric Ulcers .. 4 new 4th year Hakeems..


حالة سريرية

الوصف الكامل Background
A 32-year-old man is admitted with bleeding ulcer.
This is his fifth episode of bleeding from gastric ulcers and he also has moderate diarrhea.
He takes no medication and has no evidence of Helicobacter Pylori infection.
Each time, his ulcers have been difficult to resolve.
His serum Gastrin level is 800 pg/mL .

1- Which neoplastic lesion is most likely to be found in this man ?
a.Small Cell Carcinoma of the Lung.
b.Gastric Adenocarcinoma.
c.Small Intestine Carcinoid.
d.Prostatic Adenocarcinoma.
e.Zollinger Ellison Syndrome.
With explanation plz ..

2- Explain how did the ( Recurrent Gastric Ulcers , Diarrhea ) develop ??

3- Depending on ur physiologic and pharmacologic information,
What is the expected effects on Ions ??
How do u stop the manifestations ??

and Questions for new Third year Hakeems Later

رجل بعمر 32 عاما يعاني من قرحة نازفة ..
هذه هي النوبة الخامسة له للنزيف من قرحة معدية وهو يعاني أيضا من اسهال متوسط ..
وهو لا يأخذ أي أدوية وليس هناك دليل على إصابته بإنتان بالملتوية البوابية ..
في كل مرة القرحة كانت صعبة العلاج ..
ومستوى غاسترين المصل لديه 800 بيكوغرام\مل ..

1- أي من الإصابات الورمية التالية هي الأكثر احتمالا عند الرجل :-
a. سرطانة صغيرة الخلايا في الرئة ..
b. كارسينومه غدية في المعدة ..
c. كارسينوئيد في الأمعاء الدقيقة ..
d. كارسينومه غدية في الموثة ..
E. متلازمة زولينجر إيليسون ..
مع التوضيح اذا في مجال ...

2- وضح كيف تطور كل من (الإسهال ، والقرحات المعدية المتكررة)؟؟

3- بناء على معلوماتكم الفيزيولوجية والدوائية :-
ما هو التأثير المتوقع على الشوارد ؟؟
كيف نوقف تظاهرات الحالة؟؟

لاحقا أسئلة للسنة الثالثة الجدد في نفس الحالة

SAMO's picture
by
السنة الخامسة


• Increase gastrine lead to production of high levels of gastric acid by the gastric mucosa rustles in recurrent ulcers in stomach and duodenum.
• In 25-50%of cases ,gastrinomas are associated with MEN1
• Requires decrease acid production . H2 blockers are ineffective but a moderate to high dose off PPI often control s the symptoms

qusei


زولينجر اليسون

qusei


strieght forward case of ZE ''zollinger ellison or gastrinoma'', although usually we should see gastrin levels over 1000, but the multiple relapses and the absence of HP infection with the absence of NSAIDs intake, all refers to ZE.
the treatment is with surgery ''if one located tumer with no metastases'', if not aplicable, then aggresive treatment with PPIs only.
about the diarrhea, I don't know the answer but if it was steatorrhea then the cause is lipase inactivation due to huge ammounts of acid passing to the duodenum.

ablackside's picture
ablackside
السنة الخامسة


strieght forward case of ZE ''zollinger ellison or gastrinoma'', although usually we should see gastrin levels over 1000, but the multiple relapses and the absence of HP infection with the absence of NSAIDs intake, all refers to ZE.
the treatment is with surgery ''if one located tumer with no metastases'', if not aplicable, then aggresive treatment with PPIs only.
about the diarrhea, I don't know the answer but if it was steatorrhea then the cause is lipase inactivation due to huge ammounts of acid passing to the duodenum.

ablackside's picture
ablackside
السنة الخامسة


سبب الاسهال هو تخريب الانزيمات البنكرياسيةEye-wink

uptodate's picture
uptodate
بعد التخرج


اذا طور المريض ....امساك و زيادة في عدد مرات التبول ووهن عام وضعف عضلي غير مفسر (خفيف)....مع الام عظمية بماذا تشك؟

uptodate's picture
uptodate
بعد التخرج


فرط نشاط جارات درق
MEN I

الفردوس
السنة السادسة


صحيح ...وهدفي من الفكرة
ان انبهكم ان معظم الاسئلة تكون بهذه الطريق ...لذا احفظو الـ men
فهي مهمة ...وانصح بمناسبة هذا السؤال فليتبرع احدكم بذكرها
في هذه المشاركة..

و موفقين

uptodate's picture
uptodate
بعد التخرج


MEN-1 Syndrome

Although most gastrinomas occur sporadically, about 20% occur in association with the multiple endocrine neoplasia (MEN) syndromes. Of these, the MEN-1 syndrome, an autosomal dominant disease with variable penetrance, is thought to result from a defect in chromosome 11.[5] It is important to distinguish ZES from other such endocrine abnormalities.
Patients with MEN-1 may have involvement of the parathyroids, pancreas, and pituitary gland, although this involvement does not always lead to excessive hormone release. About 80% of patients with MEN-1 have a pancreatic tumor, the most common form of which is a gastrinoma (seen in 40%-50% of cases). An insulinoma occurs in about 20% of patients and, less commonly, a glucogonoma and vipoma occur in 3% and 1% of cases, respectively.

Gastrinomas in patients with MEN-1 are usually multiple, and about 30% found in this setting are malignant. It is now believed that gastrinomas in MEN-1 patients occur more commonly in extrapancreatic sites, such as the wall of the proximal duodenum. Duodenal gastrinomas are usually solitary in sporadic cases, whereas they are usually multiple in the MEN-1 syndrome. When the MEN-1 syndrome is suspected, serum levels of calcium, prolactin, luteinizing hormone, follicular stimulating hormone, and growth hormone should be measured. A strong family history of kidney stones (hypercalcemia) or ulcer disease may also suggest MEN-1 syndrome

ablackside's picture
ablackside
السنة الخامسة


www.medscape.com

ablackside's picture
ablackside
السنة الخامسة


to make it easy
remeber 3 p
1-pituitary
2-parathyroid
3-pancrias

uptodate's picture
uptodate
بعد التخرج
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