Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with a several-month history of progressive epigastric pain radiating to the back, associated with significant unintentional weight loss (approx. [X] kg over [X] months). Pain is described as constant, dull, and exacerbated by supine positioning. Denies jaundice, pruritus, or change in stool caliber. No history of chronic pancreatitis or family history of malignancy.
Clinical Examination Findings
General: Patient appears cachectic, chronically ill, and in mild distress. Abdomen: Soft, non-distended, with deep tenderness in the epigastrium; no palpable masses or hepatosplenomegaly. Skin: No jaundice or scleral icterus. Lymphatics: No palpable supraclavicular (Virchow’s) or axillary lymphadenopathy.
Treatment Protocol
Plan: 1. Urgent CT abdomen/pelvis with pancreatic protocol to assess tumor extent and vascular involvement. 2. CA 19-9 tumor marker assessment. 3. EUS-FNA for tissue diagnosis. 4. Pain management with scheduled analgesics and consideration for celiac plexus block. 5. Nutritional support via dietician consultation for pancreatic enzyme replacement therapy (PERT). 6. Multidisciplinary tumor board referral for surgical candidacy evaluation.