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No matter what inputs coming in there is only 1 output site

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Histamanergic agonist

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Somatostatin regulated parietal cells. Histamine regulates it we want Histaminergic antagonist. Cholinergic input neurally.

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reatment of tumors

An operation to remove the tumors that occur in Zollinger-Ellison requires a skilled surgeon because the tumors are often small and difficult to locate. If you have just one tumor, your doctor may be able to remove it surgically, but surgery may not be an option if you have multiple tumors or tumors that have spread to your liver. On the other hand, even if you have multiple tumors, your doctor still may recommend removing a single large tumor.

In some cases, doctors advise other treatments to control tumor growth, including:

Removing as much of a liver tumor as possible (debulking)

Attempting to destroy the tumor by cutting off the blood supply (embolization) or by using heat to destroy cancer cells (radiofrequency ablation)

Injecting drugs into the tumor to relieve cancer symptoms

Using chemotherapy to try to slow tumor growth

Having a liver transplant

Treatment of excess acid

Excess acid production can almost always be controlled. Medications known as proton pump inhibitors are the first line of treatment. These are effective medications for decreasing acid production in Zollinger-Ellison syndrome.

Proton pump inhibitors are powerful drugs that reduce acid by blocking the action of the tiny "pumps" within acid-secreting cells. Commonly prescribed medications include lansoprazole (Prevacid), omeprazole (Prilosec, Zegerid), pantoprazole (Protonix), rabeprazole (Aciphex) and esomeprazole (Nexium).

Long-term use of prescription proton pump inhibitors, especially in people age 50 and older, has been associated with an increased risk of fractures of the hip, wrist and spine, according to the Food and Drug Administration. This risk is small and should be weighed against the acid-blocking benefits of these medications.

Octreotide (Sandostatin), a medication similar to the hormone somatostatin, may counteract the effects of gastrin and be helpful for some people.

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H2 antagonists and proton pump inhibitors for treatment

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H2 antagonists and proton pump inhibitors for treatment

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Octreotide (Sandostatin), a medication similar to the hormone somatostatin, may counteract the effects of gastrin

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Proton pump inhibitors to decrease acid

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Proton pump inhibitors

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how is the activity of a parietal cell regulated.  Which would be the most effective drug target site

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how is the activity of a parietal cell regulated.  Which would be the most effective drug target site

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Reduce acid secretion by blocking proton pump in acid secreting cells.

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Is it HER2 positive?

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1. tumour removal - will never remove it all
2. pharmacologically - pump inhibitors

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Surgical removal of gastrinoma
Chemotherapy (If not surgically accessible)
Proton Pump Inhibitors: esomeprazole
prevents acid entering the stomach, relieving ulcer pain and permitting healing

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Breakdown of stomach lining

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Surgical removal of gastrinomas or chemotherapy drugs to treat if this isn’t possible

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the secretion stimulation test is carried out to check the digestive function of the pancreas- abnormal results may indicate chronic pancreatitis, CF or pancreatic cancer- this is not enough alone for diagnosis and other tests need to be carried

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Medications known as proton pump inhibitors are the first line of treatment. These are effective medications for decreasing acid production in Zollinger-Ellison syndrome. Proton pump inhibitors are powerful drugs that reduce acid by blocking the action of the tiny "pumps" within acid-secreting cells

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Is “13 mg/100mL” correct? If normal calcium levels are 8.8-10.4 mg/dL surely this man has over 10x the typical blood [Ca]?

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Radioactive substance injected & labels the tumour cells

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Prevent vomiting (anti nausea)
re hydration tablets
avoid foods with high acidity

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radioactive tracers attach to somatostatin receptors in tumour cells

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CT scan- rumours and ulcers
MRI- internal organ pictures
Endoscopic ultrasound- she’s gastronomas in the pancreas & angiograms

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Endoscopic ultrasound for Zollinger-Ellison syndrome diagnosis :)

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Endoscopic ultrasound for Zollinger-Ellison syndrome diagnosis :)

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Which is thought to prevent acid reflux normally

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Calcium is high and Phosphorus is low compared to normal ranges - what does this indicate? Is it common of Z-E?

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Measuring stomach acid and by doing an endoscopy. Multiple small ulcers in the distal duodenum in the patient seen in an endoscopy.

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Hyperplasia of G cells secreting excess gastrin

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Hyperplasia of G cells secreting excess gastrin

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Patient has gastrinoma caused by high levels of gastrin produced. Increased gastrin leads to ulceration due to the high production of acid.

Tests:
- pH test
-biopsy - Endoscopy
- imaging tests
--> Done to determine or conclude initial diagnosis.

Therapy
- high doses of proton pump inhibitors.
- Surgery likely to be recommended to the patient in case study. Surgery ai removing the primary tumour for ucre and reduces risk of metastatic disease.

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can be caused by tumors in the pancreas or duodenum called gastrinomas that secrete large amounts of gastrin

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Not ulcer as helicobacter -ve

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Gastrin levels are increased in Zollinger-Ellison syndrome. Diagnosis of the syndrome is certain when the plasma gastrin level exceeds 1000 pg/mL --- symptoms like stomach pain, diarrhea, or peptic ulcers that keep coming back

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Gastrin levels are increased in Zollinger-Ellison syndrome. Diagnosis of the syndrome is certain when the plasma gastrin level exceeds 1000 pg/mL --- symptoms like stomach pain, diarrhea, or peptic ulcers that keep coming back

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Gastrin producing tumour. Normal gastrin serum levels are only up to 180pg/ml and excessive amounts can lead to diarrhoea, heart burn and stomach pain

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Proton pump inhibitors to block acids, if spread to liver then somatostatin analogues can be used

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If he has Z-E, he could be given a proton-pump inhibitor to decrease acid production

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Reducing amount of stomach acid produced. Medication such as Proton pump inhibitors are common e.g Prevacid.
-Surgery and chemotherapy

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High levels of gastric lead to excessive acid production and the formation of stomach ulcers which is what may be causing the abdominal discomfort

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Secretin inhibits gastrin release in normal subjects.

A condition in which a gastrin-secreting tumour or hyperplasia of the islet cells in the pancreas causes overproduction of gastric acid, resulting in recurrent peptic ulcers.

A health care provider diagnoses Zollinger-Ellison syndrome based on the following:

medical history

physical exam

signs and symptoms

blood tests

upper gastrointestinal (GI) endoscopy

imaging tests to look for gastrinomas

measurement of stomach acid

A health care provider treats Zollinger-Ellison syndrome with medications to reduce gastric acid secretion and with surgery to remove gastrinomas. A health care provider sometimes uses chemotherapy when tumours are too widespread to remove with surgery.

Proton Pump Inhibitors (PPIs) stop the mechanism that pumps acid into the stomach, helping to relieve peptic ulcer pain and promote healing. They act by irreversibly blocking the H⁺/K⁺ ATPase (gastric proton pump) of the gastric parietal cells. The proton pump is the terminal stage in gastric acid secretion, being directly responsible for secreting H⁺ ions into the gastric lumen, making it an ideal target for inhibiting acid secretion.
Effective mechanism of action because blocking output is easier than blocking multiple inputs.

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causes high gastrin levels. Ulcers can be caused by gastronomas which can increase calcium levels. Secretion test suggests gastronoma. Can confirm with CT and biopsy.

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you up

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Tumour growth causes the progressive symptoms

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Possible

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Gastrin-secreting tumour that causes excess gastrin so too much acid

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Could have a tumour (gastrinomas) in your digestive system that could be secreting gastrin.

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H. pylori +ve indicates stomach ulcers. Ways to test:

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H. pylori +ve indicates stomach ulcers. Ways to test:

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a urea breath test – you'll be given a special drink containing a chemical that's broken down by H. pylori; your breath is then analysed to see whether or not you have an H. pylori infection

a stool antigen test – a small stool sample is tested for the bacteria

a blood test – a sample of your blood is tested for antibodies to the H. pylori bacteria (antibodies are proteins produced naturally in your blood and help to fight infection); this has now largely been replaced by the stool antigen test

If you test positive for H. pylori, you'll need treatment to clear the infection, which can heal the ulcer and prevent it returning.

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why is his BP high, are values given rather than guesswork

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why is his BP high, are values given rather than guesswork

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Any increase in serum gastrin concentration > 110 pg/mL above baseline after secretin stimulation test is a diagnosis of Zollinger- Ellison Syndrome

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Diagnostic Laparoscopy or biopsy to confirm tumour
CT scan

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A 45 year old man visits his GP complaining of abdominal pain, heartburn, nausea, blood in his vomit, bleeding from his anal passage and diarrhoea. He tells his GP that he has had these symptoms for a number of years and they have progressively got worse.
His doctor takes a blood sample which he sends off for U&E analysis.  The following data is returned for the serum: Calcium 13 mg/100ml; phosphorus 1.7 mg/100 ml, Helicobacter Pylori negative
The GP refers him to an outpatients clinic for further tests.  Prior to these, the patient is advised not to eat for 12 hours beforehand.  At the clinic, a blood sample is taken which show the man has serum gastrin level of 1220 pg/ml.  The Doctor then performs a secretin stimulation test, the outcome of which is that the mans serum gastrin concentration had increased by 246 pg/ml 15 minutes after secretin administration
•       What is the cause of this mans symptoms and why?
•       What additional tests should the clinic undertake to confirm this initial diagnosis
•       What would you suggest be the 1st and secondary therapies for the man and why?

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Symptoms lean towards this = backing up of blood pressure into other anastomoses would cause the anal bleeding and vomiting blood

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Secretin stimulation test results increase > 200ng/L suggest GASTRINOMA, this geezer has increase of 0.246 ng/L