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: 1040959
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1. Pancreatic cancer
2. Mr. F 74MPresented 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 admissionIntroduction
3. On admission, developed focus of infectionPharyngitisBlood 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 HOPC
4. Pancreatic cancer diagnosed in Oct 2014Period 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 stentHOPC
5. Referral to A/Prof. Gary RichardsonWork-upCT and endoscopic US revealed locally invasive pancreatic cancerLymph node biopsy did not show malignancyStagingT4N0M0AJCC stage IIIHOPC
6. Palliative chemotherapyAbraxane/GemcitabineWas not candidate for chemoradiotherapy or surgical resection Management
7. ComplicationsHydronephrosis – required ureteric stentsSBO – requires restentingFebrile neutropeniaPancreatic insufficiencySteatorrhoeaWeight loss and anorexiaEuglycaemicCA19-9 From 800’s down to 122 in late JanPRogress
8. Rectal polypectomy in 2007Osteoarthritis – on regular analgesicsMS contin 10mg BDPanadol Osteo 665mg TDSHypertensionHyperlipidaemiaOn Esomeprazole and nizatidine for symptoms of GORDNKDAPast medical history
9. Home with wifeTwo daughtersPreviously fit and IADLGolfed twice weeklyFunctional declineSOBOE and decreased exercise toleranceSocial history
10. 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 Summary
11. Pancreatic cancer and complicationsChemotherapy toxicityAdvanced planningSocial issues Issues