PHGY 313 Chapter : 16- Gastrinoma_questions.docx
17 Jul 2013
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Symptoms persisted with omeprazole so underwent a selective vagotomy of vagal nerves to stomach. Her basal acid secretion in response to pentagastrin was investigated and abnormal plasma gastrin levels were found. An endoscopy revealed hypertrophy of the gastric ruggae and ulceration in the 2nd stage duodenum. A ct scan showed a mass in her pancreas. Removal of the tumor (gastrinoma) cured her symptoms and gastrin levels: identify the mechanisms by which the increase in gastrin levels produced the symptoms in this patient and the mechanism of acid and pepsinogen secretion. Gastrinoma tumours secrete excessive amounts of gastrin and pepsin into the portal blood stream. Gastrin is released from g cells and stimulates acid release from oxyntic cells (both directly via cck-b receptors and indirectly via ecl cells and histamine). The neural control is by the vagus nerve and sympathetic nerves. To decrease acid secretion: d cells secrete somatostatin, a potent inhibitor of g cells and ecl activatedby.
