doc_clotaire
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A 55-year-old man presents with abdominal pain and diarrhea for the
past 3 months. He has also noticed a weight loss of 10 lb during this
period. He denies nausea, vomiting, melena, or hematochezia. He
consumes five to six beers each weekend, smokes half a pack of
cigarettes a day, but has never used intravenous drugs. The past
medical history is significant for osteoarthritis, newly diagnosed
diabetes on a trial diet for 2 months, and recurrent duodenal ulcers
found on four separate upper endoscopies. He takes
diclofenac/misoprostol and famotidine 40 mg bid. Three years ago, he
had taken triple antibiotics to treat H. pylori. He also tells you
that tumors run in his family. His vital signs are normal. Physical
examination is significant for mild epigastric tenderness to deep
palpation without radiation. Routine labs ordered show: WBC 8,500/mm3,
hemoglobin 13.4 g/dL, hematocrit 40.1%, platelets 256,000/mm3, amylase
155 U/L, sodium 141 mEq/L, potassium 4.2 mEq/L, chloride 106 mEq/L,
CO2 23 mm Hg, BUN 15 mg/dL, creatinine 1.0 mg/dL, glucose 188 mg/dL,
and calcium 11.2 mg/dL (elevated). What test would you order next?
(A) Serum lipase
(B) Upper endoscopy with biopsy
(C) Abdominal ultrasound
(D) Fasting serum gastrin level
(E) Liver enzyme studies
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| Adam
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I'm thinking of Zollinger-Ellison, the best test is Secretin test but it's not in the choices..
Fasting serum gastrin level, won't help so much, s the patient already take H2 blocker ( Famotidine) which increase the gastrin itself..I'm a bit confused,, anyway I'll go with (C) Abdominal ultrasound
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| muna
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d
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| Justice
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MEN I
(D)
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| vanshita
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B
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| doc_clotaire
Forum Guru
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Posts: 1,269
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Answer:
(D) Fasting serum gastrin level
Explanation:
This patient's history of "tumors in the family" is consistent with
MEN-1 (hyperparathyroidism, gastrinomas, and pituitary tumors). He
presents with symptoms of gastrinoma, such as recurrent ulcer
refractory to multiple treatments (H. pylori regimen and high-dose H2
blockers) and diarrhea. He also has an incidental hypercalcemia most
likely secondary to his underlying diagnosis of MEN-1. The diagnosis
of gastrinoma requires the demonstration of fasting hypergastrinemia
and an increased basal gastric output.
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| nany
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bravo Justice
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