Hypergastrinemia is associated with which disease?

HP CHO -9 October 2022

Medical & Surgical Nursing

Hard

Appeared in: HP CHO -9 October 2022

Explanation

Pernicious anemia is an autoimmune disease that causes chronic atrophic gastritis, leading to the destruction of parietal cells in the stomach.
Parietal cells produce hydrochloric acid. Their destruction results in achlorhydria, a lack of stomach acid.
Normally, stomach acid suppresses gastrin release from G-cells. In achlorhydria, this negative feedback is lost.
The absence of acid feedback leads to continuous stimulation of G-cells, causing them to overproduce gastrin, which results in hypergastrinemia.

Option A: Constipation is a disorder of bowel motility and water absorption in the colon. It has no direct pathophysiological link to gastrin levels.
Option C: Cholelithiasis, or gallstone disease, is related to the saturation of bile with cholesterol or bilirubin and gallbladder stasis. It is not influenced by gastrin levels.
Option D: Perforation is an acute, life-threatening complication, often of a peptic ulcer, not a chronic disease state characterized by hypergastrinemia. While Zollinger-Ellison syndrome (a cause of hypergastrinemia) can lead to ulcers that perforate, perforation itself is the event, not the underlying disease.

Clinical Relevance

Nursing practice connection: Knowing Pathophysiological association between hypergastrinemia and gastrointestinal diseases helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Understanding the link between pernicious anemia and hypergastrinemia is crucial for diagnosis. An elderly patient with megaloblastic anemia, low B12, and very high gastrin levels strongly suggests pernicious anemia.
Nurses should be aware that long-standing hypergastrinemia in pernicious anemia acts as a growth factor on certain gastric cells (like ECL cells), increasing the long-term risk of developing gastric carcinoid tumors.
What if? If a patient had hypergastrinemia but also very high stomach acid levels (hyperchlorhydria), the primary suspicion would shift from pernicious anemia to Zollinger-Ellison syndrome, which is caused by a gastrin-producing tumor.

How to Approach the Question

First, identify the key term in the question: 'Hypergastrinemia'. Define this in your mind as 'high levels of gastrin'.
Next, analyze the options provided, which are all medical conditions.
Recall the function of gastrin: it stimulates stomach acid secretion.
Consider the pathophysiology of each option in relation to gastrin and acid secretion.
Evaluate 'Pernicious anemia'. Recall that it involves autoimmune destruction of parietal cells, which make acid. The lack of acid (achlorhydria) removes the negative feedback on gastrin production, leading to high gastrin levels. This is a strong match.
Quickly rule out the other options: Constipation (motility), Cholelithiasis (bile), and Perforation (complication) are not primarily defined by a chronic state of hypergastrinemia.

Concept Tested & Keywords

Concept Tested: Pathophysiological association between hypergastrinemia and gastrointestinal diseases.
Stem keywords: Hypergastrinemia, disease
Lead-in keywords: associated with
Negative lead-in flag: false

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E6 Pathology- ROBBINS & COTRAN PATHOLOGIC BASIS OF DISEASE 10TH Ed pp. 771-773, 774-776

E6 Physiology Guyton 4SAE Part 2B p. 2