Pathophysiology
group of pathologic conditions caused by hypersecretion of gastric acid secondary to a gastrinoma
Signs and Symptoms
1) peptic ulcer often in second-fourth part of duodenum or in jejunum 2) diarrhea (often steatorrhea-like) 3) gastric bleeding/hematemesis 4) melena 5) duodenal perforation 6) epigastric tenderness
Characteristic Test Findings
Laboratory – 1) fasting serum gastrin > 1000 pg/ml 2) basal acid output (BAO) > 15 mEq/h 3) hypercalcemia (if part of MEN-1) 4) BAO to MAO > 0.6 5) increase in gastrin in secretin stimulation test Radiology – 6) hypertrophied gastric folds similar to Menetrier’s disease on upper GI series 7) gastrinoma often not seen on CT scan or MRI 8) visceral angiography may show tumor blush and enable localization 9) somatostatin receptor scintigraphy and endoscopic ultrasound have good sensitivity and specificity for localization
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