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Mock Grand Rounds

Mock Grand Rounds. Group 3 Clinical Clerk Batch 2012 S Y 2011-2012. Identifying Data . L.S. 64-year-old Female Widower Roman Catholic Tondo , Manila. Chief Complaint. Remittent hypogastric pain x 6 months. Temporal Profile. Tea- colored urine. Loss of appetite. Jaundice.

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Mock Grand Rounds

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  1. Mock Grand Rounds Group 3 Clinical Clerk Batch 2012 SY 2011-2012

  2. Identifying Data • L.S. • 64-year-old • Female • Widower • Roman Catholic • Tondo, Manila

  3. Chief Complaint Remittent hypogastric pain x 6 months

  4. Temporal Profile Tea-colored urine Loss of appetite Jaundice Weight Loss Abdominal Pain 6 wks PTA 4 wks PTA 2 wks PTA 1 wk PTA 4 days PTA Admission

  5. Past Medical History: • (+) Osteoarthritis, right ankle – took unrecalled medication for 1 month • (-) HTN, DM, asthma, CA • (-) Hepatitis B or C • FMHx: (-)HTN, DM, CA, liver disease • SHx: nonsmoker, non-alcoholic beverage drinker

  6. Physical Examination

  7. Physical Examination

  8. Approach to Jaundice

  9. Imaging

  10. Pertinent Findings • 64/F • Intermittent, Progressive Left-sided Pain over 6 months (3/10  5/10  8/10) • (+) Weight loss • (+) Abdominal enlargement • (+) Jaundice x 1 month PTA • (+) Tea-colored urine x 1 month PTA

  11. No particular timing of the day • Not associated with food intake • No changes in bowel movement • No nausea and post-prandial vomiting • No fever • No fatty food intolerance • No pruritus • No maintenance medications • No altered mental status • Non-alcoholic • No history of abdominal trauma

  12. Physical Exam Findings • Icteric sclerae • (+) Jaundice • Globular abdomen, soft • (-) Edema

  13. Left-sided Abdominal Pain • Pancreas • No vomiting, fever; Not entirely ruled out • Spleen • No episodes of acute bleeding or bruises • Descending Colon • No changes in bowel movement • Gastric/Duodenal Ulcer • Pain not associated with food intake

  14. Jaundice • Drug-Induced • No recent or chronic intake of medicines • Carotenoderma • Not fond of vegetables • Liver Pathology • Non-alcoholic, left-sided pain, no edema, no fever

  15. Jaundice • Gallbladder Pathology • No radiation to right shoulder, no fatty food intolerance, no vomiting, no post-prandial pain, (-) Murphy’s sign • Biliary Tree Pathology • No fatty food intolerance; Not entirely ruled out • Pancreatic Pathology • Non-alcoholic

  16. Abdominal Enlargement • Liver Pathology (Ascites) • Non-alcoholic, Liver span = 9, • Mass (Colorectal Ca, Ovarian Ca, Uterine leiomyoma) • No palpable masses; Not entirely ruled out • Obesity • (+) weight loss • Hypoalbuminemia

  17. Primary Impression • Pancreatic pathology • Pancreatic Head Mass • Biliary tree pathology • Periampullary Mass

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