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

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

Hx Cont’d

Family Hx:• Father had hypertension and CVD• Mother had diabetes and chronic pancreatitis

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

Dietary Habits

• Low in vegetables and fruits• High in red meat• High in sugar-sweetened drinks

Physical Examinations

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

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

DDx

• What test should we order?• What organs should we check for?

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

What’s Next? O.o?

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

Diagnosis

???

Treatment

???