A 40-Year-Old Man Comes to the Office Due to Recurrent

question 143

Multiple Choice

A 40-year-old man comes to the office due to recurrent epigastric abdominal pain, nausea, and watery diarrhea for the past several months.  The patient has had similar burning pain previously and was treated for peptic ulcer disease.  He has been taking over-the-counter antacids but with no significant symptom relief.  The patient does not use tobacco, alcohol, or illicit drugs.  Vital signs are within normal limits.  Abdominal examination shows mild epigastric tenderness and increased bowel sounds.  Testing for stool occult blood is positive, and laboratory studies show microcytic hypochromic anemia.  Serum gastrin level is markedly elevated.  Upper gastrointestinal endoscopy reveals prominent gastric folds and multiple ulcers in the duodenum and proximal jejunum.  Given these findings, this patient should be assessed for a personal or family history of which of the following conditions?

• A)Cerebellar hemangioblastomas
• B)Mucosal neuromas
• C)Plexiform neurofibromas
• D)Recurrent nephrolithiasis
• E)Thyroid malignancy

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Definitions:

Hepatic Vein

A vein that drains deoxygenated blood from the liver back into the circulatory system towards the heart.

Hepatopancreatic Sphincter

A muscular valve controlling the flow of digestive juices from the liver and pancreas into the small intestine.

Pancreatic Juice

This is a digestive fluid secreted by the pancreas composed of enzymes and bicarbonate ions that aid in the digestion of proteins, fats, and carbohydrates in the small intestine.

Dentin

A hard, dense tissue forming the bulk of a tooth beneath the enamel, protecting the inner pulp and transmitting nerve signals.