Zollinger-Ellison syndrome

Severe peptic ulcer disease secondary to elevated gastrin levels from a gastrinoma.

0.1% of cases of peptic ulcer disease.

As many as two-thirds of patients have chronic gastroesophageal reflux disease and its complications.

Ulcerations can involve the small intestine.

Epigastric tenderness most common physical finding.

75% of ulcers present in the first portion of the duodenum.

Ulcers can be single or multiple.

Nearly 10% have no evident ulcer, with ulcers in the 2nd, 3rd and 4th portions of the duodenum or jejunal involvement suggesting the diagnosis.

Gastrin level greater than 1000 pg/mL virtually diagnostic.

Results from gastrin producing neuroendocrine tumor, a gastrinoma, with two thirds of these lesions are malignant.

Most gastrinomas arise in an area bounded by the porta hepatitis, neck of the pancreas and the third portion of the duodenum, the gastrinoma triangle.

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