git - calidoc4u

[ArchivalUser]

55-year-old man presents with abdominal pain and diarrhea for the past 3 months. He has also noticed a weight loss of 10 lb during this period. He denies nausea, vomiting, melena, or hematochezia. He consumes five to six beers each weekend, smokes half a pack of cigarettes a day, but has never used intravenous drugs. The past medical history is significant for osteoarthritis, newly diagnosed diabetes on a trial diet for 2 months, and recurrent duodenal ulcers found on four separate upper endoscopies. He takes diclofenac/misoprostol and famotidine 40 mg bid. Three years ago, he had taken triple antibiotics to treat H. pylori. He also tells you that tumors run in his family. His vital signs are normal. Physical examination is significant for mild epigastric tenderness to deep palpation without radiation. Routine labs ordered show: WBC 8,500/mm3, hemoglobin 13.4 g/dL, hematocrit 40.1%, platelets 256,000/mm3, amylase 155 U/L, sodium 141 mEq/L, potassium 4.2 mEq/L, chloride 106 mEq/L, CO2 23 mm Hg, BUN 15 mg/dL, creatinine 1.0 mg/dL, glucose 188 mg/dL, and calcium 11.2 mg/dL (elevated). What test would you order next??

(A) Serum lipase
(B) Upper endoscopy with biopsy
© Abdominal ultrasound
(D) Fasting serum gastrin level
(E) Liver enzyme studies

[ArchivalUser]

well i think as he has a history of tumors in family + he has elevated Ca++. So the answer is C.

[ArchivalUser]

D) Zollinger-Ellison Syndrome, but this patient needs to be screened for MEN-I as well.

[ArchivalUser]

si,

ulcers resistant to treatment. D and then work up the rest.

[ArchivalUser]

this patient is on a H2 blocker. so his gastrin levels will b elevated anyway. can we still count on using serum gastrin levels ??

[ArchivalUser]

dont we suspect MEN1 n do n usg to look for adrenal tumors

[ArchivalUser]

DD

[ArchivalUser]

@diabolic, MEN-I is easier to remember as you may only remember the 3 "P" - Pituitary, Parathyroid and Pancreas.

[ArchivalUser]

Ddddd