A 45-Year-Old Man Comes to the Emergency Department After an Episode

question 119

Multiple Choice

A 45-year-old man comes to the emergency department after an episode of coffee-ground emesis.  During the past 6 months, he has had intermittent abdominal pain and heartburn partially relieved by over-the-counter antacids.  The patient also complains of explosive diarrhea that has not responded to dietary modifications.  Two months ago, he stopped consuming milk without relief.  He is a lifetime nonsmoker.
His blood pressure is 133/70 mm Hg and pulse is 89/min.  There are no orthostatic changes.  He has moderate epigastric tenderness without rebound.
Laboratory results are as follows:

Upper gastrointestinal endoscopy shows 2 small ulcers in the duodenal bulb with clean bases and a 1.2-cm ulcer in the very proximal jejunum.
Which of the following is most likely to establish the diagnosis in this patient?

• A)Jejunal ulcer biopsy
• B)Response to triple therapy
• C)Serum 5-hydroxyindoleacetic acid level
• D)Serum gastrin level
• E)Serum tryptase level

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