Mr F 74M Presented to Cabrini Malvern ED Temp 396 Vomiting of food content 34 hours postprandial Other symptoms of delayed gastric emptying Abdominal discomfort Early satiety Anorexia Loss of weight ID: 359494
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Pancreatic cancerSlide2
Mr. F 74M
Presented to Cabrini Malvern EDTemp 39.6Vomiting of food content, 3-4 hours post-prandial Other symptoms of delayed gastric emptyingAbdominal discomfortEarly satietyAnorexiaLoss of weightBackground of locally invasive pancreatic cancer Previously admitted for SBOAlso had episode of febrile neutropenia requiring admission
IntroductionSlide3
On admission, developed focus of infection
PharyngitisBlood culture showed strep. pyogenes bacteraemiaManaged on benzylpenicillin Concurrently, investigations for his gastric outlet symptoms Blockage at site of duodenal stent Could not restent, but opened obstruction
HOPCSlide4
Pancreatic cancer diagnosed in Oct 2014
Period of increasing GORD symptoms and abdominal crampsEpisode of vomiting and abdominal pain required admission under which a gastroscopy was performedFull stomach consistent with gastric outlet obstructionFollow-up CT demonstrated large pancreatic mass Stricture at D3-4 junctionEndoscopic ultrasound and FNA cytologySuspicious of adenocarcinoma consistent with clinical and radiological presentationDuodenal stent
HOPCSlide5
Referral to A/
Prof. Gary RichardsonWork-upCT and endoscopic US revealed locally invasive pancreatic cancerLymph node biopsy did not show malignancyStagingT4N0M0AJCC stage IIIHOPCSlide6
Palliative chemotherapy
Abraxane/GemcitabineWas not candidate for chemoradiotherapy or surgical resection ManagementSlide7
Complications
Hydronephrosis – required ureteric stentsSBO – requires restentingFebrile neutropeniaPancreatic insufficiencySteatorrhoeaWeight loss and anorexiaEuglycaemicCA19-9 From 800’s down to 122
in late Jan
PRogressSlide8
Rectal
polypectomy in 2007Osteoarthritis – on regular analgesicsMS contin 10mg BDPanadol Osteo 665mg TDSHypertensionHyperlipidaemiaOn Esomeprazole and nizatidine for symptoms of GORDNKDA
Past medical historySlide9
Home with wife
Two daughtersPreviously fit and IADLGolfed twice weeklyFunctional declineSOBOE and decreased exercise toleranceSocial historySlide10
Mr. F 74M
Presented with pharyngitis and strep. pyogenes bacteraemiaTreated with benzylpenicillin, d/c with amoxycillin Concurrent SBO from blockage at site of previous stentReopened but awaiting restentingSome biochemical improvement with chemotherapy Ongoing complications of pancreatic disease and chemotherapy side effects SummarySlide11
Pancreatic cancer and complications
Chemotherapy toxicityAdvanced planningSocial issues Issues