8/16/2019 Cancer of Pancreas (Answer)

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Carcinoma of head of pancreas

A male, 60 years old, was hospitalized on February because of upper

abdominal dull pain and discomfort associated with systemic progressive

yellow staining skin (anthochromia!" #wo months ago he got sustained

abdominal pain which referred to the lower back, accompanied by loss of appetite, abdominal fullness and gradually reduced body weight" $ody

eamination% hepatomegaly (enlarged &iver! without tenderness (pressing

pain!, below the right costal arch touched a 'duckegg' sized oval mass which

was soft and no tenderness" )ray eamination showed his duodenum bending

and epanded, the descending portion of the medial wall of the duodenum

mucosal teture aberrant" $ ultrasound showed the pancreatic head

thickened, the common bile duct epanded and gallbladder enlarged" Clinical

diagnosis% pancreatic head cancer, obstructive *aundice"

+lease analysis% hat structures were oppressed by the pancreatic head

cancer to cause the abovementioned signs and symptoms- hat was the

'duckegg' sized oval mass-

Summary

.ue to the common bile duct runs down to the posterior medial wall of the

descending department of duodenum and *oins with the pancreatic duct to

form the hepatopancreatic ampulla which opens to the ma*or duodenal

papilla" #hus the pancreatic head cancer can compress the *unction of the

common bile duct and the pancreatic duct which makes them happen

obstruction and results in the bile and pancreatic /uid discharge dicult to

cause the corresponding signs and symptoms"A" #he bile could not /ow to duodenum to cause common bile duct epand,

hepatomegaly and gallbladder epansion" #he 'duckegg' size oval mass

was the epanded gallbladder" 1eanwhile, the bile leaked into the blood

from the hepatic cholangioles and resulted in the yellow staining skin and

the yellow staining deepened gradually"

$" 2n the early stage the visceral neuralgia was caused by the pressure of bile

duct and pancreatic duct increased" hile in the late stage the cancer

invaded and oppressed the celiac pleus to cause pain which could refer to

the lower back"

C" #he bile and pancreatic /uid could not /ow into the duodenum to cause

the digestion and malabsorption symptoms"

." $ecause the descending portion and the horizontal part of the duodenum

surrounded the head of pancreas, when the pancreatic head cancer

in3ltrated or pushed the duodenum to the right, the )ray 3lms would

show the duodenum curve and epand and the mucosal teture of the

medial wall of descending portion of duodenum aberrant"