🩹 Zollinger-Ellison Syndrome Screening Simulator

Multiple Refractory Peptic Ulcers

Ulcers that resist treatment or recur signal a possible underlying gastrinoma.

• Duodenum: Typical ulcer sites (placeholder short note)
• High: Refractory rate flag (placeholder short note)
• Rare: Prevalence (placeholder short note)
• Recurrence: Key clue (placeholder short note)

Clinical red flags for gastrinoma

Placeholder: refractory or multiple ulcers prompt gastrin workup.

Placeholder highlight: suspect ZES in atypical ulcer cases.

Fasting Serum Gastrin Elevation

Elevated fasting gastrin is the key initial screening marker.

• <100 pg/mL: Normal gastrin (placeholder short note)
• >1000 pg/mL: ZES threshold (placeholder short note)
• Fasting blood: Test type (placeholder short note)
• PPIs: Confounders (placeholder short note)

Interpreting fasting gastrin levels

Placeholder: gastrin level guides further testing decisions.

Placeholder highlight: very high gastrin is near diagnostic.

Gastrinoma-Driven Acid Overproduction

Unregulated gastrin secretion drives massive gastric acid output.

• Elevated: Basal acid output (placeholder short note)
• Parietal cell drive: Mechanism (placeholder short note)
• Diarrhea: Symptom (placeholder short note)
• Perforation risk: Complication (placeholder short note)

Consequences of excess acid

Placeholder: excess acid causes ulceration and diarrhea.

Placeholder highlight: acid overload damages mucosa broadly.

Secretin Stimulation Test — Paradoxical Rise

Secretin injection paradoxically raises gastrin in gastrinoma.

• No rise: Normal response (placeholder short note)
• Paradoxical rise: ZES response (placeholder short note)
• +200 pg/mL: Positive cutoff (placeholder short note)
• High: Test sensitivity (placeholder short note)

Why secretin paradoxically stimulates gastrinoma

Placeholder: tumor cells respond abnormally to secretin.

Placeholder highlight: paradoxical rise confirms gastrinoma diagnosis.

Imaging Localization of the Gastrinoma

Imaging pinpoints tumor location for treatment planning.

• Pancreas/duodenum: Common site (placeholder short note)
• Somatostatin PET: Imaging modality (placeholder short note)
• Moderate: Malignancy risk (placeholder short note)
• Surgical planning: Next step (placeholder short note)

Localization and treatment planning

Placeholder: imaging guides surgical or medical management.

Placeholder highlight: precise localization enables curative resection.