1. Anatomy
   1. parietal cell
      1. HCL secreation
         1. Increase secreation
            1. Histamine
            2. Alcohol, coffee
            3. Protein
            4. Catacholemine, adrenalline
            5. cf: Glucose x
            6. Gastrin
         2. Suppresion
            1. Somatostatin
         3. 7AM Lowest
      2. Instrinsic factor
         1. VitB12
   2. Chief cell
      1. Pepsin
   3. D cell
      1. Somatostatin
   4. K cell
      1. GIP
   5. G cell
      1. Gastrin
         1. ZE syndrome
         2. Retained antrum
         3. Pyloric obstruction
         4. Vagal stimulation
         5. s/p PPI
         6. H. P infection
         7. Hypercalcemia
         8. coffeem lipid, glucose intake
         9. Renal failure
         10. HyperPTH
         11. atrophic gastritis
2. zollinger-Ellison syndrome
   1. Gastrinoma
      1. 50-70% in duodenum
      2. 20-40 % in pancrease
         1. Delta cell
         2. 60% malianant
   2. M > F
   3. S/S
      1. Ulcer
         1. most in Duodenum
      2. GERD
      3. Diarrhea
      4. 25% with MEN-1
   4. 必須高度懷疑者
      1. 頑固多發性非典型部位之潰瘍
      2. 胃切除後復發
      3. 有腹瀉
      4. 有異常黏膜皺摺
      5. 並有其他內分泌瘤症狀
      6. WIth hypercalcimia
   5. DX
      1. BAO/MAO >0.6
      2. Fasting gastrin >150pg/ml (>500-1000pg/ml
      3. Secretin test
      4. Calcium infusion test
      5. Standard meal test
      6. Image study
         1. Most sensitive: EUS
         2. CT. MRI, PES, angiography,
3. Dumping syndrome
   1. Early dumping
      1. 15-30mins
      2. Osmotic fluid into gut
      3. Abdominal s/s, vasomotor s/s
   2. Late dumping
      1. 2-4hrs
      2. elevation of insulin
4. Gastritis
   1. Type A
      1. Autoimmune
      2. Parietal cell desturction
      3. Pernicious anemia
      4. Gastric cancer
   2. Type B
      1. H. P related
      2. Antrum
   3. Menetrier's disease
      1. Giant hypertrophic gastritis
      2. Serum album leak to gastric juice
      3. Hypoalbuminemia
5. H. P infection
   1. Only colonized in Antral mucosa
   2. 95-100% DUs, 70-80% GUs
   3. GNB, with filamen, aerobic
   4. Dx
      1. Breath test
      2. PES
      3. Serum Abx for follow up, not screen
   5. Tx 10-14d
      1. Amoxicillin, clarithromycin, PPI
      2. Bismuth, Metronidazole, Tetracycline, PPI
      3. Metronidazole, Clarithromycin, PPI
6. Gastric ulcer
   1. Portion
      1. Antrum
         1. Less malignancy
      2. Greater curve
         1. More malignancy
   2. Must biopsy
   3. Post-prandial pain
   4. Elevation of Gastrin
   5. Tx:
      1. PPI, H2B
      2. Eradication of H. P
   6. Dieulafoy's ulcer