Gastro

Question 1

When to obtain a fasting serum gastrin level?

Answer 1

-Multiple ulcers
-Ulcers in usual locations, associated with severe esophagitis; resistant to therapy with frequent recurrences; in the absence of hpylori and nsaid cause
-Ulcer patients awaiting surgery
-Extensive family history of PUD
-Postoperative ulcer recurrence
-unexplained diarrhea or steatorrhea
-Hypercalcemia
- family history of pancreatic islet, pituitary or parathyroid tumor
-prominent gastric duodenal folds

Question 2

What level of Fasting serum gastrin for all gastrinoma patients?

Answer 2

> 150-200pg/ml

Normal <150pg/ml

Question 3

Conditions with elevated fasting gastrin level

Answer 3

most frequent -gastric hypochlorhydia and achlorhydia +/- pernicious anemia

Others: retained gastric antrum, G hyperplasia, gastric outlet obstruction, renal insufficiency massive small bowel obstruction, and conditions such as rheumatoid arthritis vitiligo, DM; pheochrocytom

Question 4

Ulcer features that should raise suspicion of gastrinoma

Answer 4

Unsual location (2nd part of duodenum and beyond), refractory to standard medical therapy, recurrence after acud reducing surgery, presentating the frank complications (bleeding, obstruction, and perforation) absence of H pylori and nsaid ingestion

Question 5

What to instruct for fasting serum gastrin level?

Answer 5

Need to stop PPI with serum gastrin levels determined at least 7 days after stopping PPI - place patient on H2 blockers and stopped 24 hrs before testing or antacids and stopping 12 hours before testing

Question 6

What pH is suggestive for gastrinoma?

Answer 6

pH <3

pH >3 does not excoude diagnosis thus need a formal gastric acid analysis

Question 7

Pathognomonic of ZES

Answer 7

BAO > 15 meq/h in the presence of gastrinemia

BAO/MAO ratio >0.6 high suggestive of ZES

Question 8

Most sensitive and specific provocative test for Dx of gastrinoma

Answer 8

Secretin stimulation test

-increased gastrub >= 120pg within 15 min of secretin

Question 9

Gastrinoma favorable prognostic factors

Answer 9

Primary duodenal proximal tumors, isolated LN tumor, undetectable tumor upon surgical exploration, presence of MEN 1

Question 10

Causes of erythema nodusom

Answer 10

SORE SHINS
(Strep, OCP, Ricketstia, Eponymous)
Sulfonamides, Hansen’s Disease, IBD, NHL, sarcoidosis

Question 11

First Biologic therapy approved for moderate to severely active CD and UC

Answer 11

Infliximab