Endocrine System Case Study 7:

 

A 25-year-old woman enters the hospital with persistent diarrhea and abdominal pain.  Laboratory results of gastrointestinal radiologic tests suggest a duodenal ulcer.  The diagnosis is confirmed by endoscopy.  Other lab results obtained the following:

 

 

When the patients gastric juice is removed via nasogastric tube evacuation during a 24-hr period, the diarrhea is corrected.  After a test meal it is found that the patientŐs gastric serum level remains the same (normally gastric serum levels double after a meal).  When given intravenous injection of secretin the patientŐs gastric serum levels rise to three times normal levels.  Also, the rate of HCL secretion can be brought to below normal levels by treatment with an H2 receptor blocker.  However, the dosage required to do this is several times greater than that usually used in patients with duodenal ulcers. 

 

1.)  Compare and contrast the mechanism of action of steroid hormones and peptide hormones.

2.)  Describe the hormonal control mechanisms of digestion.

3.)  Why might the patient have an elevated rate of HCL secretion?

 

4.)  How would you expect the patientŐs rate of pepsinogen secretion to compare with normal?

 

5.)  What is the difference between a duodenal ulcer and a gastric ulcer?

 

6.)  What causes the excess fat in the stool?

 

7.)  Why does the patient not have an increase in gastric serum levels after a test meal?

 

8.)  What role is secretin playing in the digestive physiology of this patient?

 

9.)  What options exist for the long-term management of this patientŐs illness?