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Adi Kartolo

Adi Kartolo. University of Ottawa. Initial Presentation. 62-year-old middle class Caucasian male Chief Complaint: pain in upper abdomen and back, significant weight loss, loss of appetite, bloating, change in bowel habit, and nausea. Develop jaundice recently. Hx.

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Adi Kartolo

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  1. AdiKartolo University of Ottawa

  2. Initial Presentation • 62-year-old middle class Caucasian male • Chief Complaint: pain in upper abdomen and back, significant weight loss, loss of appetite, bloating, change in bowel habit, and nausea. • Develop jaundice recently.

  3. Hx • Has been diagnosed with pancreatitis before. • Not taking any medication currently.

  4. Hx Cont’d Family Hx: • Father had hypertension and CVD • Mother had diabetes and chronic pancreatitis

  5. Hx Cont’d Social/Occupational Hx: • Retired; used to work as a high school teacher • Sedentary lifestyle • No history of substance abuse • Has been smoking and drinking for about 20 years

  6. Dietary Habits • Low in vegetables and fruits • High in red meat • High in sugar-sweetened drinks

  7. Physical Examinations • BMI: 25 • Waist circumference: 38 inches • BP: 119/76 mmHg • HR: 84 beats/minute • RR: 12 breaths/minute • Normal body temperature

  8. More Examination • Lungs are clear to auscultation and percussion, no rales or wheezes • No focal motor or sensory deficits • Examiner felt a mass in the center of the abdomen

  9. DDx • What test should we order? • What organs should we check for?

  10. Imaging Studies • Abdominal Ultrasound • Abdominal CT (Computed Tomography) • Endoscopy: endoscopic retrograde cholangiopancreatography (ERCP) vs. laparoscopy • Biopsy: percutaneous vs. endoscopic • Results indicate the presence of a tumor in the head of the pancreas

  11. What’s Next? O.o?

  12. Results of the further studies • Blood test indicates an elevation of CA 19-9 in the blood. • Microscopic examination indicates metatasis towards lymph node and liver

  13. Diagnosis ???

  14. Treatment ???

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