In Carcinoma head of pancreas, Nausea & vomiting is due to:
Ans. (a) External Compression of duodenumRef: Blumgarts 6th ed; pg. 979; Sabiston 20th ed; pg. 1544* Pancreatic adenocarcinoma develops in the ductal cells and are called Ductal Adenocarcinoma.* They most commonly occur on the Right side, i.e., Head and Uncinate Process (60-70%) than left side, i.e., Body and Tail of pancreas (20-25%)* Features of Carcinoma Head of Pancreas are# Jaundice 75%# Weight loss 51%# Abdominal pain 39%# Nausea/vomiting 13%# Pruritus 11%# Fever 3%# Gastrointestinal bleeding 1%* For tumors at the body and tail of pancreas, Pain (most common) and weight loss are the presenting features as they present at a late advanced stage* Regarding Nausea and vomiting, they occur due to tumor extrinsic compression of duodenum C loop presenting a state of Gastric outlet obstruction.* In unresectable cases, these patients should be offered Endoluminal duodenal metal stent as palliation.
External Compression of duodenum
Portal vein infiltration
Proliferation infiltration of tumor into duodenum
Chemotherapy related
Pancreas