Zollinger-Ellison syndrome
Zollinger-Ellison syndrome - peptic ulcer of the stomach and duodenum [or gastroentero (duodeno) anastomosis after gastrectomy], caused by hypergastrinemia arising from hyperplasia of the G cells of the antral stomach (type I syndrome) or with the development of a tumor from the D-cells of the islet apparatus Pancreas, producing gastrin (type II syndrome - gastrinoma). Approximately 60% of tumors of the islet apparatus are malignant. In 30% of patients, single or multiple benign adenomas are detected and in 10% of the hyperplasia of the D-cells of the islet apparatus. Gastrinoma can be located outside the pancreas, more often in the wall of the duodenum. In 25% of patients with Zollinger-Ellison syndrome, adenomas of other endocrine organs - parathyroid glands, pituitary gland, adrenal glands (multiple endocrine adenomatosis) are found.
Symptoms, course. Abdominal pain and diarrhea. Pain in the abdomen is typical for peptic ulcer, however it is very intense and does not lend itself to antacid therapy. Diarrhea is pathogenetically associated with hypersecretion of hydrochloric acid: the degree of secretion of hydrochloric acid exceeds the possibility of neutralizing it in the duodenum, acidic content enters the jejunum and causes the development of enteritis. The emergence of diarrhea is also associated with inactivation of pancreatic enzymes; In addition, as a result of hypergastrinemia, peristalsis of the intestine is intensified, and the absorption of water in it decreases. The course of peptic ulcer in the syndrome of Zollinger-Ellison is very difficult: often ulcers are complicated by bleeding, perforation; Relapses of peptic ulcer occur even after surgical treatment. The localization of ulcers is very diverse: the descending section of the duodenum, even the jejunum.
In the diagnosis, the study of gastric secretion, which has a number of features, is important: over 12 hours the secretion of gastric juice exceeds 1500 ml; The level of basal secretion exceeds 15 mmol / h (the norm of 2-3 mmol / h); After the administration of the maximum dose of histamine, there is no increase in the production of hydrochloric acid. The most reliable diagnostic method is radioimmunochemical determination of gastrin in blood plasma. If a healthy human gastrin content in the plasma is 50-200 pc / ml, then with Zollinger-Ellison syndrome it can exceed 500 pg / ml. Stimulation of the secretion of gastrin with calcium or serotonin allows differentiating between types 1 and 2 of the syndrome.
Treatment. At 1 type of a syndrome (a hyperplasia of G-cells of an antral department of a stomach) resection of an antral department of a stomach is shown. In type II, the search for gastrinoma and its removal are justified. However, this is difficult to do, especially since 20% of patients have microadenomatosis and islet D-cell hyperplasia. Therefore, only the removal of the entire stomach (gastrectomy) completely eliminates the relapse of ulcers.
The forecast is always very serious. Even with an unsuccessful pancreatic tumor after gastrectomy, the level of gastrin is reduced to normal, there is a regression of distant metastases.
- Surgical diseases
- Abscess
- Abscess appendicular
- Abscesses of the abdominal cavity
- Abscess of the Douglas space
- Intestinal abscess
- Abscess of the lung
- Soft tissue abscess
- Abscesses of soft tissues after injection
- Abscess of liver
- Amoebic liver abscess
- Prostate adenoma
- Actinomycosis
- Aneurysm
- False aneurysm
- True aneurysms
- Aneurysm of the aortic arch
- Aneurysm of descending thoracic aorta
- Dissecting Aneurysm
- Aneurysm of the abdominal aorta
- Aneurysm of peripheral vessels
- Arteriovenous aneurysm
- Aneurimas of the heart
- Appendicitis acute
- Perforation of the appendage
- Appendicular infiltration
- Pielephlebitis
- Atheroma
- Bronchoectasis
- Varicose veins
- Varicose veins of the spermatic cord
- Dropsy of testis and spermatic cord
- Rectal prolapse
- Gangrene gas
- Gangrene lung
- Hemorrhoids
- Hydradenite
- Gynecomastia
- Hernia
- Internal hernias
- Hernias of the esophagus
- External hernias
- Herniated hernias
- Herniated hernia
- Hernia of the white line
- Hernia postoperative ventral
- Herniated hernia
- Rare hernias
- Pincushion
- Phlegmon hernial sac
- False infringement of a hernia
- Hernias with inflammation
- Dumping syndrome
- Diverticulum
- Esophagus diverticulum
- Cervical diverticulum
- Bifurcation diverticulum
- Epiphrenial diverticulum
- Epiphrenial diverticulum
- Diverticulum of the stomach
- Diverticulum of the duodenum
- Meckel's diverticulum
- Jaundice mechanical
- Bile duct stones
- Ventilated stone of choledoch
- Papillotenosis
- Stricture of bile ducts
- Cancer of the head of the pancreas
- Cholelithiasis
- Urinary retention acute
- Foreign bodies of bronchi
- Foreign bodies of the stomach
- Foreign bodies of the esophagus
- Foreign bodies of soft tissues
- Carbuncle
- Brushes and fistulas of the neck are lateral
- Cysts and fistulas of the neck median
- Colitis ulcerative ulcerative
- Coccygeal epithelial passage
- Cryptorchidism
- Bleeding
- Bleeding internal
- Bleeding gastrointestinal
- Varicose veins
- The Mallory-Weiss Syndrome
- Bleeding into the abdominal cavity
- Bleeding pulmonary
- Bleeding external
- Parenchymal hemorrhage
- Crohn's disease
- Lymphadenitis
- Lymphangitis
- Mastitis
- Putrefactive mastitis
- Acute non-lactational mastitis
- Chronic mastitis
- Megacolon
- Mediastinitis
- Intestinal obstruction
- Paralytic intestinal obstruction
- Mechanical intestinal obstruction
- X-ray diagnostics
- Specific types of intestinal obstruction
- Ingrown throat
- Frostbite
- Local cooling
- Burn
- Occlusion of the main arteries
- Acute occlusion of the vessels of the extremities
- Acute occlusion of mesenteric vessels
- Chronic occlusions of arterial vessels
- Obtiterating atherosclerosis
- Aortic ileal type
- Hips and popliteal type
- Peripheral type
- Occlusion of aortic arch branches
- Occlusion of carotid arteries
- Occlusion of the subclavian artery
- Takayasu's syndrome (absence of pulse)
- Chronic occlusion of mesenteric vessels (abdominal toad)
- Stenosis of the renal arteries
- Obliterating thrombangitis
- Raynaud's disease
- Orcoepididymitis
- Acute abdomen
- Acute pancreatitis
- Chronic pancreatitis
- Acute cholecystitis
- Panaritium
- Panaritium cutaneous
- Paronichy
- Panaritium subungual
- Panaritium tendinous
- Panaritium articular
- Panaritium bone
- Penetrating ulcer of the stomach and duodenum
- Peritonitis
- Peritonitis chronic
- Piopevneumotorax
- Pneumothorax spontaneous
- Postcholecystectomy syndrome
- Perforated ulcer
- Covered perforation
- Bedsore
- Prostatitis
- Wounds
- Fistulas of the rectum
- Stenosis of the outlet stomach
- Fracture of anus
- Urethritis
- Phimosis, paraphimosis
- Phlebothrombosis
- Occlusion of subclavian vein
- Phlegmon
- Furuncle
- Cholangitis
- Electric trauma
- Empyema of the pleura
- Congenital intestinal obstruction
- Atresia of the anus
- Congenital cholangiopathy of newborns
- Pylorostenosis
- Embryonic hernia (hernia of umbilical cord)
- Exstrophy of the bladder
- Dropsy of shells of testis and spermatic cord
- Surgical diseases of the chest
- Congenital diaphragmatic hernia
- Congenital cysts of the lungs
- Pneumothorax
- Tracheophishoprine fistula
- Mastitis of newborns
- Acute hematogenous osteomyelitis
- Peritonitis in newborns
- Acute paraproctitis
- Necrotic phlegmon of newborns
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