Zollinger-Ellison Syndrome and Cirrhosis

Question 1

What is CEA?

Answer 1

Carcinoembryonic antigen. It is a cancer marker for colorectal cancer

Question 2

What is CA153, CA125 and CA199?

Answer 2

CA153 - breast cancer
CA125 - Ovarian cancer
CA199 - Pancreatic cancer, gall bladder cancer, bile duct cancer, and gastric cancer

Question 3

What is Zollinger-Ellison syndrome?

Answer 3

It is a condition where peptic ulcers are associated with gastrin-secreting tumours (gastrinoma). Gastrin stimulates the secretion of excessive gastric acid and this results in multiple ulcers in the duodenum and stomach.

Question 4

What are the signs and symptoms of Zollinger-Ellison syndrome?

Answer 4

Abdominal pain, dyspepsia, and chronic diarrhoea due to the inactivation of pancreatic enzymes (from the low pH). There may also be steatorrhoea.

Question 5

What tests are done to determine if someone has Zollinger-Ellison syndrome?

Answer 5

Fasting serum gastrin levels: >1000pg/mL is diagnostic.
IF fasting serum gastrin level is 100-1000pg/mL and ZES is suspected, do the next test:

Secretin stimulation test: There will be raised serum gastrin level (>200pg/mL)

Question 6

When to suspect Zollinger-Ellison Syndrome?

Answer 6

If there are:

• Multiple peptic ulcers
• Ulcers found distal to the duodenum
• FHx of peptic ulcers
• FHx of pituitary, parathyroid, islet cells (pancreatic) adenomas

Question 7

Which adenomas are associated with Zollinger-Ellison Syndrome?

Answer 7

Pituitary, Parathyroid and Pancreatic (Islet cells) adenomas

Question 8

What are the signs of hypoalbuminaemia?

Answer 8

Oedema and Leuconychia

Question 9

What is the life threatening condition that portal hypertension can lead to? Why will it be caused?

Answer 9

Oesophageal varices due to portosystemic shunting, Oesophageal varices which may haemorrhage.