ZES

Question 1

What is Zollinger Elisson syndrome?

Answer 1

It’s a cancer in gastrin producing cells ➡️ Gastrinoma

Question 2

What are the causes for ZES?

Answer 2

Unknown

<20% of ZES cases are ass. With MEN1 Syndrome or parathyroid, pituitaryand pancreas tumors.

Question 3

What are the S&S for ZES?

Answer 3

1-ulcer that is resistance to 💊 ( multiple, extensive)
1/2 in duodenum, 1/4 in pancreas

2-chronic diarrhea not improving with 💊 ( 2/3 of ptn )

3-maybe hypercalcemia as in cases ass. With MEN syndrome

4- 30% will have metastasis at presentation

Question 4

How can you diagnose ZES?

Answer 4

1- measure serum gastrin ( PIPs must be stoped 1 week before the test )

if gastrin test is abnormal ➡️
2- Do secretin stimulation test

3-another way to diagnose is to find both elevated ( gastric acid & gastrin ) ⬆️

4-after confirming the diagnosis look for metastasis & hypercalcemia

5-Endoscopy to check ulcers

6-US, contrast CT of pancreas and nearby areas to find the tumor, and MRI
Or nuclear test,somatostatin-receptor scintigraphy for metastasis

7-Endoscopic US is the single most sensitive test

Question 5

How can you 💊 ZES?

Answer 5

Surgical removal for localized lesion

• PPI (Omeprazole) to block acid production ➡️ suppress metastatic disease

Question 6

What causes gastrin ⬆️?

Answer 6

1. pernicious anemia
2. chronic gastritis
3. renal failure
4. hyperthyroidism