Which of the following is a rare disease in which tumours cause the stomach to produce too much acid, resulti… - MNS 2024

MNS 2024

Medical & Surgical Nursing

Easy

Appeared in: MNS 2024

Explanation

Zollinger-Ellison syndrome (ZES) is a rare condition caused by gastrin-secreting tumors, known as gastrinomas, which are typically found in the pancreas or duodenum.
These tumors release excessive amounts of the hormone gastrin into the bloodstream.
The high levels of gastrin cause massive stimulation of the stomach's parietal cells, leading to extreme gastric acid hypersecretion.
This hyperacidity results in severe, often multiple, and treatment-resistant peptic ulcers in the stomach, duodenum, and sometimes the jejunum.

Option A: Boerhaave syndrome is a full-thickness perforation of the esophagus, an acute event typically caused by forceful vomiting. It is not a chronic condition involving tumors or acid hypersecretion.
Option C: Mallory-Weiss syndrome is a non-penetrating mucosal tear at the gastroesophageal junction, which causes bleeding. It is also often related to forceful vomiting but does not involve tumors or the chronic overproduction of stomach acid.
Option D: Abdominal compartment syndrome is a condition of dangerously increased pressure within the abdominal cavity, which impairs organ perfusion. It is unrelated to gastric acid production or tumors and is typically a complication of trauma or major surgery.

Clinical Relevance

Nursing practice connection: Knowing Pathophysiology of Zollinger-Ellison Syndrome helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Nurses should maintain a high index of suspicion for ZES in patients who present with peptic ulcers that are severe, recurrent, located in unusual sites (e.g., post-bulbar duodenum or jejunum), or are resistant to standard medical therapy.
A key nursing action for a suspected case is to ensure that a fasting serum gastrin level test is ordered and drawn correctly, as this is the primary diagnostic marker.
What if? If a patient diagnosed with ZES also shows signs of hypercalcemia (due to hyperparathyroidism) or has a family history of endocrine tumors, the nurse should recognize the potential for Multiple Endocrine Neoplasia type 1 (MEN1). This is critical as it changes the management plan to include screening for other tumors (pituitary, parathyroid) and requires genetic counseling for the patient and family.

How to Approach the Question

First, analyze the question to identify the key defining features of the condition: 1) presence of tumors, 2) excessive stomach acid production, and 3) resulting peptic ulcers.
Systematically evaluate each option against this triad of features.
Recognize that Boerhaave syndrome and Mallory-Weiss syndrome are both related to physical trauma to the esophagus (rupture and tear, respectively), usually from vomiting, and are not caused by tumors or chronic acid hypersecretion. This allows you to eliminate them.
Identify that Abdominal Compartment Syndrome is a pressure-related problem within the entire abdomen, unrelated to the stomach's acid-producing function.
Conclude that Zollinger-Ellison syndrome is the only option that matches the specific pathophysiology described: a tumor (gastrinoma) that causes hypersecretion of acid, leading to peptic ulcers.

Concept Tested & Keywords

QojUZQeuUV2f7XRBZ0T09o

E6 Pathology- ROBBINS & COTRAN PATHOLOGIC BASIS OF DISEASE 10TH Ed p. 774-776

E6 Nursing Brunner Adult Health 3SA Vol 1 Part 2 p. 141-143

E6 Medicine Davidson Principles Practice 24e p. 822-824