Zollinger-Ellison syndrome

Zollinger-Ellison syndromeZOLLINGER - ELLISON SYNDROME peptic ulcer of stomach and duodenum [or gastroentero (duodeno)anastomosis after resection of the stomach], due to hypergastrinemia, resulting in hyperplasia of G cells of the antrum (type I syndrome) or with tumor development from D-cells of islet apparatus of the pancreas that produce gastrin (type II syndrome - gastrinoma). Approximately 60% of tumors islet apparatus are malignant. In 30% of patients detect single or multiple benign adenomas and 10%-hyperplasia D-cells of islet of the apparatus. Gastrinoma may be located outside of the pancreas, often in the duodenum. In 25% of patients with syndrome Zollinger - Ellison detect adenomas other endocrine organs - the parathyroid glands, pituitary, adrenal (multiple endocrine adenomatosis). The symptoms for. Abdominal pain and diarrhea. Abdominal pain typical of peptic ulcer, but it is very intensive and not amenable to antacid therapy. Diarrhea pathogenetically associated with hypersecretion of hydrochloric acid: the degree of secretion of hydrochloric acid exceeds its neutralization in the duodenum, the acidic content enters the jejunum and causes the development of enteritis. The occurrence of diarrhea is also associated with the inactivation of pancreatic enzymes; in addition, as a result of hypergastrinemia increases intestinal peristalsis, reduces the absorption of water in it. Peptic ulcer disease syndrome Zollinger - Ellison very difficult: often ulcer complicated by bleeding, perforation; the recurrence of ulcers occur even after surgical treatment. Localization of ulcers in this most diverse: downward Department dvenadcatiperstnoy intestine, even jejunum. In the diagnosis are important to the study of gastric secretion, has a number of features: for 12 h, the secretion of gastric juice exceeds 1500 ml; basal secretion level greater than 15 mmol/h (normal 2-3 mmol/h) after administration of the maximum dose of histamine does not increase the production of hydrochloric acid. The most reliable method of diagnosis is radioimmunochemical determination of gastrin in the blood plasma. If a healthy person the contents of gastrin in plasma is 50-200 PC/ml syndrome Zollinger - Ellison it can exceed 500 PG/ml Stimulation allocation gastrin using calcium or serotonin allows to differentiate 1 and II types of syndrome. Treatment. When 1 type syndrome (hyperplasia of the G cells of the antrum) shows the resection of the antrum. When type II justified the search gastronomy and its removal. However, to make it difficult, especially considering the fact that 20% of patients have microadenomas and hyperplasia of islet D cells. Therefore, only the removal of the entire stomach (gastrectomy) is completely possible to eliminate the recurrence of ulcers. The weather is always very serious. Even when undeleted pancreatic tumor after gastrectomy gastrin level drops to normal, marked regression of distant metastases..



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