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A 45-year-old male presents with abdominal pain, diarrhea

45 years old | Male

Vignette:

A 45-year-old male presents with abdominal pain, diarrhea, and heartburn. Physical exam is unremarkable. On endoscopy he is found to have multiple gastric and duodenal ulcers. The patient is prescribed proton-pump inhibitors and treated for Helicobacter pylori, which relieves his symptoms temporarily. However, he has multiple recurrences of symptoms and ulcers.

Summary:

abdominal pain | diarrhea | heartburn | endoscopy multiple gastric ulcer | endoscopy multiple duodenal ulcer | proton-pump inhibitors | Helicobacter pylori | multiple recurrences | recurrent ulcers

Dx:

Zollinger-Ellison Syndrome Gastrinoma

Ref:

https://online.epocrates.com/diseases/408/Gastrinoma

Rank

Disease

Weight

1 Zollinger-Ellison Syndrome 396.0
2 Duodenal Ulcer 267.0
3 Gastric Ulcer 267.0
4 Acute peptic ulcer 232.0
5 Giardiasis 225.0
6 Peptic Ulcer 220.0
7 pancreatic cancer 217.0
8 Crohn Disease 205.0
9 Hereditary Angioedema 204.0
10 Bacterial gastroenteritis 190.0
11 Intestinal Entamoeba histolytica amebiasis 186.0
12 Irritable Bowel Syndrome 164.0
13 Hemolytic uremic syndrome 161.0
14 Food poisoning 161.0
15 mucosal Eosinophilic gastroenteritis 160.0
16 Peritoneal dialysis associated peritonitis 159.0
17 Intestinal Pseudo Obstruction 156.0
18 Gastritis 156.0
19 Listerial gastroenteritis 154.0
20 Non-cholera Vibrio infections 150.0
21 Endometriosis 148.0
22 Lactose intolerance 143.0
23 Mesenteric ischemia 142.0
24 Adrenal crisis 140.0
25 Amebic Liver Abscess 135.0
26 Acute Appendicitis 134.0
27 Eosinophilic gastroenteritis 132.0
28 Muscle Layer Eosinophilic gastroenteritis 132.0
29 subserosal eosinophilic gastroenteritis 132.0
30 Gastric Volvulus 131.0
31 Gastrointestinal Hemorrhage 130.0
32 Lower gastrointestinal hemorrhage 130.0
33 Upper gastrointestinal hemorrhage 130.0
34 Sigmoid volvulus 129.0
35 Acute intermittent porphyria 125.0
36 Shigellosis 124.0
37 Campylobacter infection 124.0
38 Choledochal Cyst 122.0
39 Ovarian Cancer 121.0
40 Acute viral meningitis 121.0
41 Viral Gastroenteritis 121.0
42 Kawasaki disease 120.0
43 Ulcerative Colitis 119.0
44 Psoas Abscess 118.0
45 Sarcoidosis 118.0
46 Salmonella infection 118.0
47 Gastroenteritis 118.0
48 Cholera 117.0
49 Tuberculous Peritonitis 116.0
50 Acute perforated appendicitis 116.0
51 Chronic Pancreatitis 114.0
52 Thrombotic thrombocytopenic purpura 112.0
53 Acute pyelonephritis in adults 112.0
54 Toxic Megacolon 111.0
55 Analgesic nephropathy 110.0
56 Churg-Strauss Syndrome 110.0
57 Systemic sclerosis 110.0
58 Foodborne E coli infection 107.0
59 Anaphylaxis 106.0
60 Gastric cancer 105.0
61 Malaria 105.0
62 Acute Cholecystitis 103.0
63 Pheochromocytoma 100.0
64 Anthrax 100.0
65 Gastroesophageal reflux disease 98.0
66 Colorectal cancer 96.0
67 Addison Disease 96.0
68 Anal Fissure 95.0
69 Esophagitis 94.0
70 Intussusception 94.0
71 Emphysematous cholecystitis 93.0
72 Systemic lupus erythematosus 92.0
73 Diverticulitis 89.0
74 Hepatocellular carcinoma 89.0
75 Celiac Disease 89.0
76 Spontaneous bacterial peritonitis 87.0
77 Klebsiella pneumoniae liver abscess 87.0
78 Autosomal Dominant Polycystic Kidney Disease 87.0
79 Intra-abdominal abscess 87.0
80 Intestinal malrotation 87.0
81 Brucellosis 87.0
82 Pyogenic Liver Abscess 86.0
83 Annular pancreas 86.0
84 Ectopic Pregnancy 86.0
85 Ruptured ectopic pregnancy 86.0
86 Ruptured Tuboovarian abscess 84.0
87 Abetalipoproteinemia 84.0
88 Biliary cyst 83.0
89 Diabetic Amyotrophy 83.0
90 Barrett esophagus 82.0
91 Acute Cholangitis 81.0
92 Choledocholithiasis 81.0
93 Renal Cell Carcinoma 81.0
94 Adrenocortical carcinoma 79.0
95 Gallstones 78.0
96 Malt lymphoma 78.0
97 Rumination Syndrome 76.0
98 Primary sclerosing cholangitis 76.0
99 Acalculous Cholecystitis 75.0
100 chronic acalculous cholecystitis 75.0
101 Ruptured ovarian cyst 75.0
102 Gallbladder cancer 74.0
103 Intestinal Obstruction 74.0
104 Autoimmune hepatitis 74.0
105 Hyperthyroidism 74.0
106 Graves Disease 74.0
107 Short bowel syndrome 74.0
108 Amebiasis 74.0
109 Achalasia 72.0
110 Kidney stones 71.0
111 Henoch-Schonlein purpura 71.0
112 Tuboovarian abscess 70.0
113 Urinary Tract Obstruction 70.0
114 Rocky Mountain spotted fever 70.0
115 Inflammatory Bowel Diseases 68.0
116 Liver Cirrhosis 68.0
117 Liver disease 68.0
118 Biliary cirrhosis 68.0
119 Primary biliary cirrhosis 68.0
120 Parkinson disease 68.0
121 Hiatus hernia 67.0
122 Fibromyalgia 67.0
123 Pelvic inflammatory disease 66.0
124 Acute pelvic inflammatory disease 66.0
125 Gastroparesis 66.0
126 Glomerulonephritis 66.0
127 Acute Renal vein thrombosis 65.0
128 Non-ST-elevation myocardial infarction 65.0
129 Erectile dysfunction 65.0
130 Diabetic Ketoacidosis 64.0
131 Aortic Dissection 64.0
132 Chronic pelvic pain in women 64.0
133 Bruxism 64.0
134 Renal and perinephric abscess 63.0
135 Panic disorder in adults 63.0
136 Alcoholic hepatitis 62.0
137 Polyarteritis nodosa 62.0
138 Pyelonephritis 61.0
139 Chronic Myeloid Leukemia 61.0
140 Diabetes Mellitus 61.0
141 Hyperprolactinemia 61.0
142 Extraintestinal Entamoeba histolytica amebiasis 59.0
143 Acute Clonorchiasis 58.0
144 Typhoid infection 55.0
145 Dyspepsia 54.0
146 Intraperitoneal bleeding 53.0
147 Acetaminophen overdose 53.0
148 Anemia of chronic disease 53.0
149 Common cutaneous drug reactions 53.0
150 Foreign body ingestion 52.0
151 Autoimmune Pancreatitis 51.0
152 Clostridium difficile infection 51.0
153 Familial adenomatous polyposis syndrome 51.0
154 Ileus 50.0
155 Acute fatty liver of pregnancy 50.0
156 Bacterial pharyngitis 50.0
157 Breast Cancer 50.0
158 Endometrial cancer 50.0
159 Osteoporosis 50.0
160 Hypothyroidism 49.0
161 Cholangiocarcinoma 48.0
162 Type 1 Diabetes mellitus 48.0
163 Multiple endocrine neoplasia 2B 48.0
164 Multiple endocrine neoplasia 2A 48.0
165 Stevens-Johnson syndrome 48.0
166 Budd Chiari Syndrome 47.0
167 Endometritis 47.0
168 Hyperosmolar Hyperglycemic state 47.0
169 Acute bacterial meningitis in children 47.0
170 Chronic bacterial prostatitis 46.0
171 Amphetamine use disorder 46.0
172 Alcoholic Liver Disease 46.0
173 Secondary Peritonitis 45.0
174 Type 2 Diabetes mellitus 45.0
175 Hyperparathyroidism 45.0
176 Hypogammaglobulinemia 45.0
177 Ovarian Hyperstimulation Syndrome 44.0
178 Pneumonia 44.0
179 Hypertriglyceridemia 44.0
180 Acute otitis media 44.0
181 Chronic Clonorchiasis 42.0
182 Epiploic appendagitis 41.0
183 Acute pericarditis 41.0
184 Meckel diverticulum 41.0
185 Abnormal uterine bleeding 41.0
186 Wilson disease 40.0
187 Bladder Cancer 40.0
188 Urinary tract infection 40.0
189 Acute Cystitis(Men) 40.0
190 Cystitis 40.0
191 Heparin-induced thrombocytopenia 40.0
192 Non-small cell lung cancer 40.0
193 Exocrine pancreatic insufficiency 40.0
194 Amyloidosis 40.0
195 Obstructive Sleep Apnea 39.0
196 Familial Mediterranean fever 39.0
197 Alcoholic Liver Cirrhosis 38.0
198 Acute Myeloid Leukemia in adults 38.0
199 Acute bacterial meningitis in neonates 38.0
200 Middle East respiratory syndrome 38.0
201 Pancreatic Pseudocyst 36.0
202 Leiomyomas 36.0
203 Hypercalcemia 36.0
204 Chronic Lymphocytic Leukemia 36.0
205 STI HIV Pharyngitis 36.0
206 Globus Sensation 36.0
207 Stable ischemic heart disease 36.0
208 Prostatitis 36.0
209 Chronic prostatitis 36.0
210 COVID19 35.0
211 Abdominal compartment syndrome 34.0
212 Chronic Kidney Diseases 34.0
213 Chronic heart failure 34.0
214 Ovarian and fallopian tube torsion 34.0
215 Guillain-Barre syndrome 34.0
216 Adrenal Suppression 34.0
217 Acute Lymphoblastic leukemia in children 34.0
218 Aortic coarctation 34.0
219 Travelers diarrhea 34.0
220 Aseptic meningitis 34.0
221 Infectious mononucleosis 32.0
222 Dubin-Johnson syndrome 32.0
223 Medullary thyroid cancer 32.0
224 Acromegaly 32.0
225 Disseminated intravascular coagulation 31.0
226 Gastric Outlet Obstruction 30.0
227 Eclampsia 30.0
228 Peutz-Jeghers Syndrome 30.0
229 Chronic Hepatitis 29.0
230 Alcoholic Fatty Liver 29.0
231 Ischemic stroke 29.0
232 Granulomatosis with polyangiitis 29.0
233 Menopause 29.0
234 Influenza 28.0
235 Multiple Sclerosis 28.0
236 Ascites 27.0
237 Inguinal hernia 27.0
238 Primary Myelofibrosis 27.0
239 Insect bites and stings 27.0
240 Diabetic Neuropathy 27.0
241 Graves ophthalmopathy 27.0
242 Peritonitis 26.0
243 Acute peritonitis 26.0
244 Hepatic Encephalopathy 26.0
245 Enterovesical fistula 26.0
246 Multiple Myeloma 25.0
247 biliary SOD 25.0
248 Cystic Fibrosis 24.0
249 Hereditary hemochromatosis 24.0
250 Sphincter of Oddi Dysfunction 24.0
251 pancreatic SOD 24.0
252 Gilbert syndrome 24.0
253 Atopic dermatitis 24.0
254 COPD Exacerbation 24.0
255 biliary colic 23.0
256 Acute Cystitis(Women) 23.0
257 Osteoarthritis 23.0
258 Renal vein thrombosis 23.0
259 Chronic Renal vein thrombosis 23.0
260 Autosomal Recessive Polycystic Kidney Disease 23.0
261 Cushing syndrome 23.0
262 Von willebrand disease 23.0
263 Psoriasis 23.0
264 Prinzmetal angina 23.0
265 Hepatorenal Syndrome 22.0
266 Hyperaldosteronism 22.0
267 Chronic fatigue syndrome 21.0
268 Cholecystitis 21.0
269 Chronic Cholecystitis 21.0
270 Asthma 21.0
271 Blepharitis 21.0
272 Mirizzi Syndrome 20.0
273 Preeclampsia 20.0
274 Vaginitis 20.0
275 Urethritis 20.0
276 Phimosis 20.0
277 Paraphimosis 20.0
278 Epidemic keratoconjunctivitis 20.0
279 Splenic Infarction 19.0
280 Gout 19.0
281 Gallbladder Dyskinesia 19.0
282 Limited cutaneous systemic sclerosis 19.0
283 Tinea versicolor 19.0
284 Rotor syndrome 18.0
285 Premature labor 18.0
286 Chronic pyelonephritis 18.0
287 Hemorrhagic stroke 18.0
288 Tinnitus 18.0
289 Atypical pneumonia 18.0
290 Premenstrual syndrome 18.0
291 End Stage Renal Disease 18.0
292 Carpal Tunnel Syndrome 18.0
293 Acute Hepatitis 17.0
294 Lung Cancer 16.0
295 Bullous pemphigoid 16.0
296 Alzheimer disease 16.0
297 Mitral Stenosis 16.0
298 Migraine headache in adults 16.0
299 Splenic abscess 16.0
300 Splenic Rupture 16.0
301 Simple kidney cyst 15.0
302 Painless thyroiditis 15.0
303 Insomnia in adults 15.0
304 Prolactinoma 15.0
305 Clonorchiasis 14.0
306 Unstable angina 14.0
307 Intrahepatic cholestasis of pregnancy 14.0
308 Systemic vasculitis 14.0
309 Secondary hyperparathyroidism 14.0
310 Anaplastic thyroid cancer 13.0
311 Extrahepatic Cholestasis 13.0
312 Intrahepatic Cholestasis 13.0
313 Goiter 13.0
314 Diffuse nontoxic goiter 13.0
315 Toxic multinodular goiter 13.0
316 Obstructive cervical goiters 13.0
317 Cervical goiter 13.0
318 Acute Liver Failure 12.0
319 Rheumatoid Arthritis 12.0
320 Stable angina 12.0
321 Psychogenic polydipsia 12.0
322 Allergic rhinitis 12.0
323 Peyronie Disease 12.0
324 Discogenic low back pain 11.0
325 Mallory-Weiss syndrome 11.0
326 Bed bugs 10.0
327 Herpes zoster 10.0
328 Aortic stenosis 10.0
329 Gestational diabetes mellitus 10.0
330 Non-alcoholic Fatty Liver Disease 9.0
331 Renal Artery Stenosis 9.0
332 Testicular cancer 9.0
333 Acute Bacterial Prostatitis 8.0
334 Ovarian Torsion 8.0
335 Umbilical hernia 8.0
336 Common cold(children) 8.0
337 Primary ciliary dyskinesia 7.0
338 Kartagener syndrome 7.0
339 Common cold(adults) 7.0
340 Diabetic Kidney Disease 7.0
341 Psoriatic arthritis 7.0
342 Acute Lymphocytic Leukemia in Adults 6.0
343 Epididymo-orchitis 6.0
344 Ramsay Hunt syndrome 6.0
345 Meniere disease 6.0
346 Pulmonary Embolism 6.0
347 Acute atrial fibrillation 6.0
348 ST-elevation myocardial infarction 6.0
349 Ankylosing spondylitis 5.0
350 Thyroid lymphoma 5.0
351 Benign Prostatic Hyperplasia 4.0
352 Drowning 4.0
353 Acute Rhinosinusitis 4.0
354 Acute viral rhinosinusitis 4.0
355 Acute bacterial rhinosinusitis 4.0
356 Migraine 3.0
357 Acute Bronchitis 2.0
358 Alopecia areata 2.0
359 Chlamydia pneumoniae infection 2.0
360 endocarditis 1.0
361 Acute Pancreatitis 0.0
362 Gallstone pancreatitis 0.0
363 Hemorrhoids 0.0
364 Immune thrombocytopenia 0.0
365 Recurrent aphthous stomatitis 0.0
366 Acute epididymitis 0.0
367 Hodgkin lymphoma 0.0
368 Motion Sickness 0.0
369 Myasthenia Gravis 0.0
370 Congenital Myasthenic Syndromes 0.0
371 Neonatal Myasthenia Gravis 0.0
372 Acute disseminated encephalomyelitis 0.0
373 Bell palsy 0.0
374 Myoclonus 0.0