Howdy friends, and welcome back to another installment of Diagnose This, the game where we test your medical knowledge and you learn some interesting and fun facts about medicine. Well, maybe not fun facts, but most certainly some incredibly important and fundamental ones.
Which brings me to last week’s case; the unfortunate female with the Stage IV pancreatic cancer. This particular condition is one that has always been an interesting one, especially with the poor prognosis and aggressive nature of cancers that occur in this vital organ. The most common type of tumor here is an adenocarcinoma, with 85% of all pancreatic exocrine tumors being of this type and arising from the pancreatic ductal epithelium. There are a few other types of tumor that can be seen within the pancreas (Pancreatic Neuroendocrine Tumors, acinar cell carcinomas, cystadenocarcinomas etc…) but for this unfortunate patient an adenocarcinoma is the diagnosis. The management of such an advanced pancreatic cancer such as this one is mainly palliative; the insertion of a stent through the tumor to relieve the obstructive jaundice and pharmacological treatment with painkillers and antiemetics is usually the way to go, making the patient as comfortable as possible for the remaining few weeks or months of their life. Finally, the five-year survival rate for pancreatic adenocarcinomas is only 1%, meaning that 99% of patients with a Stage IV pancreatic adenocarcinoma will die within 5 years.
Sorry for the sad case guys, but unfortunately this is the nature of medicine; sometimes there is no cure and the best we can do is to make the patient and their families as comfortable and happy as possible.
So, this week we will be working off the condition matrix that the year 3B students have received! This means that, as well as learning from our incredibly well-written blog (at least that is what my mum says) you will be able to cross of some of those pesky conditions that are currently causing anxiety amongst a large proportion of you.
A patient 72 year old man of Caucasian ethnicity presents to the ED complaining of pain in the left iliac fossa for a few hours. On examination he has a temperature of 37.8C and evidence of localised peritonitis. After talking with the patient’s wife it is discovered that he has little to no dietary fibre intake and has had increased flatulence and a change in his normal bowel habits for the past year. His FBE shows increased WCC and CRP/ESR.
What is the preliminary diagnosis, what other investigations should be performed, and what should the management be for this patient (both immediate and long term)?
Find out next week on Diagnose This, exclusive to bloodbonesandbodies!