Management of chronic PUD/GERD on the Step 2 CK exam

by / Monday, 31 May 2010 / Published in Internal Medicine

This is a question you are likely to see on all USMLE exams.

Patient presents with un-remitting epigastric pain, even after trials of PPI’s or H2-receptor antagonists.

Always be conscious of Zollinger-Ellison syndrome, which is a rare disorder that causes more than 1 gastrinoma in the pancreas or duodenum.  They are gastrinomas and may be malignant up to 50% of the time.

How to manage this patient?

The CK exam is going to ask you “What is the next best step?” OR “What is the most appropriate next step?”.  The answer is going to be to get a fasting serum gastrin level, and looking for >1000 pg/ml is the diagnostic level to look for.

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