Clinical---Zollinger Ellison Syndrome...
Zollinger Ellison syndrome is a rare disease in which a tumor develops in the pancreas or the upper part of the small intestine (duodenum).
Clinical Diseases
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Referance: Davidsons principles and Practice of Medicine
(Post এর শেষ কিছু ছবি রেখেছি Zollinger Ellison Syndrome Related.. দেখে নিয়েন..)
What is ZE Syndrome?
Zollinger Ellison syndrome is a rare disease in which a tumor develops in the pancreas or the upper part of the small intestine (duodenum).
(এই Tumors গুলোকে বলে Gastrinomas. এগুলো Benign আবার Malignant হতে পারে তবে most of the case Benign হয়...)
Pathophysiology of ZE syndrome?
(Gastrinoma tumor গুলো Large amount Gastrin secret করে... আমরা জানি, gastrin হল হরমোন যেটা আমাদের stomach এ HCL ACID secretion কে stimulated করে। তহ স্বাভাবিকভাবেই Gastrin এর কারণে stomach acid hypersecretion হয়.. আর এই HCL acid hypersecretion হওয়ার কারনে Peptic ulcer disease develop করে এবং chronic diarrhoea হয়....)
Triad of ZE Syndrome:
*Pancreatic or duodenal tumor
*Gastric acid hypersecretion
*Peptic ulcer disease
Cause of ZE syndrome:
Autosomal dominant syndrome called multiple endocrine neoplasia type - 01(MEN 1). Primary tumor দেখা যায় pancreas, duodenum, abdominal lymph node. Ectopic locations are heart, overy, liver, kidney.About 25% of people who have gastronomas have them as part of MEN-1(multiple endocrine neoplasia type - 01).
Now Sign symptomes of ZE-Syndrome:
*Abdominal pain*Diarrhoea
*Heartburn and acid reflex
*Gastro-esophageal reflex disease
*Unexplained weight loss
*Bleeding in the digestive tract
*Decreased appetite
*Nausea vomitting
Investigation of ZE Syndrome
*Serum gastrin level :
(সেরামে gastrin level 10-1000 fold elevated থাকবে)
*Gastric acid secretory test---positive হবে।
*upper intestinal endoscopy
*CT SCAN (show tumors and ulcers)
Treatment:
*Drug:
(proton pump inhibitors:esomiprazole, lansoprazole, pantoprazole, omeprazole)
(নরমালি Proton pump inhibitor গুলো
HCL secretion কমায়, এরা irreversibly block করে hydrogen-potassium-Atpase pump of stomach... যার কারনে stomach থেকে HCL secretion কমে যায়, ফলে peptic ulcer হওয়ার চান্স কমে যায়)
*Surgery
(to remove gastrinomas)*chemotherapy
(when tumors are too widespread to remove with surgery)
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