Zollinger-Ellison syndrome


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Zollinger-Ellison syndrome

ETP Gastrointestinal System - HV


Anatomy of the gastrointestinal organs of the pelvis and perineum

Anatomy of the oral cavity (dentistry)

Anatomy of the pharynx and esophagus

Anatomy of the anterolateral abdominal wall

Anatomy of the abdominal viscera: Blood supply of the foregut, midgut and hindgut

Anatomy of the abdominal viscera: Esophagus and stomach

Anatomy of the abdominal viscera: Small intestine

Anatomy of the abdominal viscera: Large intestine

Anatomy clinical correlates: Anterior and posterior abdominal wall

Abdominal quadrants, regions and planes

Development of the digestive system and body cavities

Development of the gastrointestinal system

Development of the teeth

Development of the tongue

Gallbladder histology

Esophagus histology

Stomach histology

Small intestine histology

Colon histology

Liver histology

Pancreas histology

Gastrointestinal system anatomy and physiology

Anatomy and physiology of the teeth

Liver anatomy and physiology

Escherichia coli

Salmonella (non-typhoidal)

Yersinia enterocolitica

Clostridium difficile (Pseudomembranous colitis)


Salmonella typhi (typhoid fever)

Clostridium perfringens

Vibrio cholerae (Cholera)



Bacillus cereus (Food poisoning)

Campylobacter jejuni

Bacteroides fragilis


Enteric nervous system

Esophageal motility

Gastric motility

Gastrointestinal hormones

Chewing and swallowing

Carbohydrates and sugars

Fats and lipids


Vitamins and minerals

Intestinal fluid balance

Pancreatic secretion

Bile secretion and enterohepatic circulation

Prebiotics and probiotics

Cleft lip and palate



Oral candidiasis

Aphthous ulcers

Ludwig angina

Warthin tumor

Oral cancer

Dental caries disease

Dental abscess

Gingivitis and periodontitis

Temporomandibular joint dysfunction

Nasal, oral and pharyngeal diseases: Pathology review

Esophageal disorders: Pathology review

Esophageal web

Esophagitis: Clinical (To be retired)

Barrett esophagus


Zenker diverticulum

Diffuse esophageal spasm

Esophageal cancer

Esophageal disorders: Clinical (To be retired)

Boerhaave syndrome

Plummer-Vinson syndrome

Tracheoesophageal fistula

Mallory-Weiss syndrome

GERD, peptic ulcers, gastritis, and stomach cancer: Pathology review

Gastroesophageal reflux disease (GERD)

Peptic ulcer

Helicobacter pylori


Peptic ulcers and stomach cancer: Clinical (To be retired)

Pyloric stenosis

Zollinger-Ellison syndrome

Gastric dumping syndrome


Gastric cancer


Small bowel bacterial overgrowth syndrome

Irritable bowel syndrome

Celiac disease

Small bowel ischemia and infarction

Tropical sprue

Short bowel syndrome (NORD)

Malabsorption syndromes: Pathology review

Malabsorption: Clinical (To be retired)

Zinc deficiency and protein-energy malnutrition: Pathology review

Whipple's disease

Appendicitis: Pathology review


Appendicitis: Clinical (To be retired)

Lactose intolerance

Protein losing enteropathy

Microscopic colitis

Inflammatory bowel disease: Pathology review

Crohn disease

Ulcerative colitis

Inflammatory bowel disease: Clinical (To be retired)

Bowel obstruction

Bowel obstruction: Clinical (To be retired)


Familial adenomatous polyposis

Juvenile polyposis syndrome

Gardner syndrome

Colorectal polyps and cancer: Pathology review

Colorectal polyps

Colorectal cancer

Colorectal cancer: Clinical (To be retired)

Peutz-Jeghers syndrome

Diverticulosis and diverticulitis

Diverticular disease: Pathology review

Diverticular disease: Clinical (To be retired)

Intestinal adhesions

Ischemic colitis



Cyclic vomiting syndrome

Abdominal hernias

Femoral hernia

Inguinal hernia

Hernias: Clinical (To be retired)

Congenital gastrointestinal disorders: Pathology review

Congenital diaphragmatic hernia

Imperforate anus



Meckel diverticulum

Intestinal atresia

Hirschsprung disease

Intestinal malrotation

Necrotizing enterocolitis


Anal conditions: Clinical (To be retired)

Anal fissure

Anal fistula


Rectal prolapse

Carcinoid syndrome

Crigler-Najjar syndrome

Biliary atresia

Gilbert's syndrome

Dubin-Johnson syndrome

Rotor syndrome

Jaundice: Pathology review



Cirrhosis: Pathology review

Cirrhosis: Clinical (To be retired)

Portal hypertension

Hepatic encephalopathy


Wilson disease

Budd-Chiari syndrome

Non-alcoholic fatty liver disease

Cholestatic liver disease

Hepatocellular adenoma

Alcohol-induced liver disease

Alpha 1-antitrypsin deficiency

Primary biliary cirrhosis


Hepatitis A and Hepatitis E virus

Hepatitis B and Hepatitis D virus

Viral hepatitis: Pathology review

Viral hepatitis: Clinical (To be retired)

Autoimmune hepatitis

Primary sclerosing cholangitis

Neonatal hepatitis

Reye syndrome

Benign liver tumors

Hepatocellular carcinoma

Gallbladder disorders: Pathology review


Gallstone ileus

Biliary colic

Acute cholecystitis

Ascending cholangitis

Chronic cholecystitis

Gallbladder cancer

Gallbladder disorders: Clinical (To be retired)


Pancreatic pseudocyst

Acute pancreatitis

Chronic pancreatitis

Pancreatitis: Clinical (To be retired)

Pancreatic cancer

Pancreatic neuroendocrine neoplasms

Pancreatitis: Pathology review

Abdominal trauma: Clinical (To be retired)

Gastrointestinal bleeding: Pathology review

Gastrointestinal bleeding: Clinical (To be retired)

Pediatric gastrointestinal bleeding: Clinical (To be retired)

Abdominal pain: Clinical (To be retired)

Disorders of carbohydrate metabolism: Pathology review

Glycogen storage disorders: Pathology review

Glycogen storage disease type I

Glycogen storage disease type II (NORD)

Environmental and chemical toxicities: Pathology review

Medication overdoses and toxicities: Pathology review

Laxatives and cathartics


Acid reducing medications


Zollinger-Ellison syndrome


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High Yield Notes

13 pages


Zollinger-Ellison syndrome

of complete

External References

First Aid








Multiple endocrine neoplasias (MEN syndromes) p. 359

Zollinger-Ellison syndrome p. 357

Peptic ulcer disease p. 389

Zollinger-Ellison syndrome p. 359


Zollinger-Ellison syndrome p. 359

Zollinger-Ellison syndrome p. 359

duodenal ulcers p. 389

gastrin in p. 380

MEN 1 syndrome p. 359

proton pump inhibitors for p. 408


Content Reviewers

Rishi Desai, MD, MPH


Brittany Norton, MFA

Tanner Marshall, MS

Evan Debevec-McKenney

Jahnavi Narayanan, MBBS

Zollinger-Ellison syndrome, named after Dr. Zollinger and Dr. Ellison - the two surgeons who first described it, is a rare endocrine disorder where there’s actually three interrelated pathologies.

First, there’s a gastrinoma, which is a gastrin-secreting tumor.

Second, the gastrinoma leads to increased gastric acid secretion from parietal cells.

Third, the excess gastric acid causes peptic ulcers.

Normally, the inner wall of the entire gastrointestinal tract is lined with mucosa, which consists of three cell layers.

The innermost layer is the epithelial layer and it absorbs and secretes mucus and digestive enzymes.

The middle layer is the lamina propria and it contains blood and lymph vessels.

The outermost layer of the mucosa is the muscularis mucosa, and it is a layer of smooth muscle that contracts and helps with the breakdown of food.

In the stomach, there are four regions - the cardia, the fundus, the body, and the pyloric antrum.

There’s also a pyloric sphincter, or valve, at the end of the stomach which closes while eating, keeping food inside for the stomach to digest.

The epithelial layer in different parts of the stomach contains different proportions of gastric glands which secrete a variety of substances.

Having said that, the cardia contains mostly foveolar cells that secrete mucus which is mostly made up of water and glycoproteins.

The fundus and the body have mostly parietal cells that secrete hydrochloric acid and chief cells that secrete pepsinogen, an enzyme that digests protein.

Finally, the antrum has mostly G cells that secrete gastrin in response to food entering the stomach.

These G cells are also found in the duodenum and the pancreas, which is an accessory organ of the gastrointestinal tract.

Gastrin stimulates the parietal cells to secrete hydrochloric acid, and also stimulates the growth of glands in the epithelial layer.


Zollinger-Ellison syndrome is a rare endocrine disorder characterized by a triad of one or more gastrinomas, increased gastric acid secretion, and peptic ulcers. The main symptom is epigastric pain from peptic ulcers, but also includes steatorrhea, weight loss, gastrointestinal bleeding, and diarrhea due to incomplete digestion and absorption. Zollinger-Ellison syndrome can be treated with acid-lowering medications and surgery to remove solitary tumors. Treatment involves reducing the production of stomach acid with medications, removing the tumor through surgery.


  1. "Robbins Basic Pathology" Elsevier (2017)
  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
  4. "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)
  5. "Gastrinoma (Duodenal and Pancreatic)" Neuroendocrinology (2006)

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