Pancreatic Carcinoma

Chapter 35 Pancreatic Carcinoma




Clinical Case Problem 1: A 62-Year-Old Man with Abdominal Pain


A 62-year-old man comes to your office for a third opinion. He has seen two other physicians during the past 3   months regarding an abdominal pain that is, according to the patient, “getting worse and worse.” It is unrelated in any way to food intake except that the patient has become significantly anorexic since the pain developed. The first physician told him that he had irritable bowel syndrome; the second physician told him that the pain was a psychoneurotic pain: “Basically, sir, that means it is all in your head.” The patient tells you that he was very disappointed with the two physicians, especially because the first one had been his family doctor for more than 15   years.


You decide to spend your time today on a focused history. The most important information you gather is (1) the patient has lost 20 pounds in 3   months; (2) the pain is constant; (3) the patient has never had abdominal pain before; (4) the patient’s mood has definitely changed during this period (in fact, the first symptom was depression, even before the pain started); and (5) the pain is central abdominal, radiating through to the back, dull and aching in character, and described as a 7/10 in terms of severity.


On examination, the patient looks “unwell.” You cannot describe it any more clearly than that. He just looks unwell. There is no clinical evidence of anemia, jaundice, or cyanosis. Examination of the abdomen reveals some tenderness in the midabdominal region. The liver edge is felt 2   cm below the left costal margin.



Select the best answer to the following questions




1. The differential diagnosis in this patient would include all except which of the following?


a. inflammatory bowel disease

b. carcinoma of the stomach

c. carcinoma of the pancreas

d. irritable bowel syndrome

e. none of the above can be excluded

2. If you could order only one investigation at this time, which one of the following would you order?


a. magnetic resonance imaging scan of the abdomen

b. gastroscopy

c. dual-phase helical computed tomography (CT) scan of the abdomen

d. colonoscopy

e. serum amylase or serum lipase

3. The appropriate investigation is ordered. What is the sensitivity of this investigation in the disorder described?


a. 70%

b. 80%

c. 90%

d. 95%

e. 100%

4. Which of the following statements regarding the relationship between this patient’s depressive symptoms and his abdominal symptoms is correct?


a. the abdominal symptoms are unrelated to the depression

b. the abdominal symptoms are indirectly related to the depression

c. the abdominal symptoms are directly related to the depression

d. the abdominal symptoms and the depressive symptoms usually do not coexist in this disorder

e. nobody really knows for sure

5. The patient had planned a vacation for the week after the investigation was performed. You persuaded him to return to your office when he returns from his vacation in 6   weeks for further evaluation. You encourage him to take his vacation because of your suspicions regarding his disease. Before he leaves for his vacation, however, you must provide the patient with one other treatment. What is the single most important treatment to be undertaken at this time?


a. begin the patient on an antiinflammatory medication

b. begin the patient on an oral corticosteroid

c. begin the patient on an antidepressant

d. begin the patient on an oral chemotherapeutic agent

e. none of the above

6. Cancer pain is an extremely important medical problem. Which of the following statements regarding the management of cancer pain in the United States is true?


a. cancer pain is extremely well managed by most U.S. physicians

b. the overtreatment of cancer pain is much more of a problem than the undertreatment of cancer pain in the United States

c. the undertreatment of cancer pain is much more of a problem than the overtreatment of cancer pain in the United States

d. most Americans with cancer die in very good control of pain; few have cancer pain that is not well controlled

e. none of the above

7. The patient returns to your office in 6   weeks after an overseas tour. Because of your therapy, he was able to enjoy most of his holiday. Three days ago, his pain began to become acutely worse. The patient now appears jaundiced. He has lost another 15 pounds, and there is a palpable mass in the periumbilical region. The investigation performed earlier is repeated, and a mass measuring 6   cm × 5   cm is now seen in the appropriate region. At this time, what should you do?


a. explore with a surgeon the possibility of a Whipple procedure

Related posts:

  1. Alcohol
  2. Colorectal Cancer and Other Colonic Disorders
  3. Sexual Dysfunction
  4. Illustrated Review

Stay updated, free articles. Join our Telegram channel
Tags:
Oct 1, 2016 | Posted by in GENERAL SURGERY | Comments Off on Pancreatic Carcinoma

Full access? Get Clinical Tree
Get Clinical Tree app for offline access