Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with chronic epigastric pain radiating to the back, associated with postprandial nausea, recurrent vomiting, and significant weight loss. History of chronic alcohol consumption noted. Symptoms suggestive of duodenal stenosis and pancreatic head involvement. No jaundice or signs of acute cholangitis currently.
Clinical Examination Findings
Abdominal examination reveals localized epigastric tenderness without rebound or guarding. Bowel sounds are present but may be diminished if gastric outlet obstruction is present. Cachexia or signs of malnutrition may be noted. Skin assessment negative for jaundice.
Treatment Protocol
Initial management includes bowel rest, nasogastric decompression if obstruction is present, and aggressive nutritional support. Pain management via non-opioid analgesics. Long-term management involves pancreatic enzyme replacement therapy (PERT), smoking and alcohol cessation, and surgical consultation for potential pylorus-preserving pancreaticoduodenectomy (PPPD) or duodenal stenting.