humpf!!
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27 y.o. man with recurrent PUD has a small pancreatic neoplam that produces large amounts of gastrin. While awaiting operation, the patient should be treated with:
a) chenodeoxycholic acid
b) methacholine
c) metoclopromide
d) omeprazole
e) sucralfate
(...and why?)
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| robin082006
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D, proton pump inhibitor to decrease HCL secretion, this patient has Gastrinoma, causing Zollinger-Ellison syndrome
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| Slacker
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E. Because Sucralfate will protect the lining of the stomach from the increased gastrin until surgical procedure can be done to remove the tumor. True this is Zollinger-Ellison syndrome and in this syndrome the islet cell starts to secrete gastrin. A proton pump inhibitor wouldn't help that much because most of the gastrin is being released from the islet cells and not the stomach. Proton pump will only inhibit the proton pump in the stomach. I don't think it will inhibit the islet cells from releasing gastrin. Correct me if i'm wrong...
Edited by Slacker on 05/18/06 - 01:05 AM
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| eaguin
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I agree with robin, the right answer is D, because proton pump inhibitors actually are the drug of choice in Zollinger-Ellison syndrome, omeprazol is the key, and really inhibit the gastrin release by the pancreas that it will act on the parietal cells of the stomach.
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| star1
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Yes Robbin is correct....... what is the function of gastrin ??
to stimulate Parietal cell to secrete HCL..
so Omeperazole is right to decrease production... will you allow the acid to be produced and then you protect mucosa or you will try to stop the production of HCL
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| Ivil
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the ans is D. Gastrin is produced by G cells that are located mainly in the antrum and the D cells of the pancreatic islets. It stimulates the secretion of Hcl by pancreatic cells either directly or indirectly via histamine.Omeprazole block HCl secretion and not the gastrin secretion.
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| tn1kinobe
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I think SLACKER is correct. Answer is E) Sucrulfate.
WHY? B/c vignette says "while awaiting operation".. means he's not going to have surgery for awhile. Merck Manual says to use cyto-protective drugs prior to surgery to help heal it.
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| Nan
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E. the MOC of Sucralfate is to form a protective gel- like coating of ulcer beds, "while waiting for the surgery."
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| drfax
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E.
coz sucralfate has more rapid action than Proton Pump inhibitors, also it has a good protective mechanism in PU,
Sucralfate also effective in treating Stess-inducing ulcers and as we know waiting for surgery is stessfull,
Proton pump inhibitors usually used for those that depend only on drugs for therapy and need time to fully recover
but this patient will undergoing surgery that will remove the causative agent, so u don't need to have a chronic drug therapy
That is what I think ,
Edited by drfax on 09/16/06 - 07:03 AM
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| klimt
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I agree with drfax. Ans is E
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| ashfaque
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ANSWER IS D . REFERENCE; OXFORD HAND BOOK OF SURGERYPAGE 906; WHICH HAS MENTION THE USE OF PROTON PUMP INHIBITOR AND ALMOST EVERY STANDARD TEXT BOOK HAS MENTION THE SAME. IT IS TRUE THAT ULCER TAKE ALONG TIME TO HEAL ALMOST 6-8 WEEKS BUT IT IS WISE TO GO WITH STATEMENT MENTIONED IN TEXT BOOKS
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