GI Neoplasia III Flashcards
Put parietal cells, chief cells, and neuroendocrine cells in order of appearance from the bottom of a gastric gland to the top
Neuroendocrine cells are deepest in the gastric gland—- then Chief cells—-then Parietal cells near the top
What do parietal cells secrete ?
acid
What do chief cells secrete
Pepsin
Pathophysiology of carcinoid tumor
Chronic gastritis or gastric acid suppression can lead to hypergastrinemia (high gastrin levels trying to stimulate more acid release)
This in turn can lead to gastric diffuse neuroendocrine hyperplasia which can develop into a gastric carcinoid tumor
What stains are used to insure that a tumor is neuroendocrine in nature?
CHROMOGRANIN and somatrophysin
What is type I carcinoid syndrome?
Tumor is associated with hypergastrinemia, usuallyindolent (slow growing), and mets are very uncommon
What is type II carcinoid syndrome?
Tumor is associated with high gastrin levels that are coming from outside the stomach (usually a pancreatic tumor or something of that sort). Treat the carcinoid syndrome but also treat the tumor
Type III carcinoid syndrome?
Not associated with hypergastrinemia, very aggressive, many with metastases at diagnosis, assoc with carcinoid syndrome
ANd what does carcinoid syndrome look like
bunch of nodules in the fundus of the stomach
What are the possible ways to treat a type 1 carcinoid tumor?
- take out the nodules
- take out the antrum of the stomach where the gastrin is coming from
Zollinger Ellison Syndrome
High levels of gastrin due to a gastrin secreting tumor in the pancreas or small intestine usually.
Diagnosis made bby gastrin level over 1,000 with gastrin pH below 5
Treatment of zollinger-ellison syndrome
- surgical resection
- High dose PPI
- Long acting somatostatin analog
Outside of the stomach, what is the most common site of a carcinoid tumor
small bowel
Where in the small intestine do carcinoid tumors generally appear?
Illeum and appendix
What age range for intestinal carcinoid tumors
late middle age
