A 60-year-old woman with a history of chronic pancreatitis comes with worsening epigastric pain radiating to the back associated with nausea and vomiting. She has lost 10 kg in the past 4 months. She has no evidence of jaundice. LFT and serum amylase/lipase are within normal limits. CT scan of the abdomen shows the following. What would be the most appropriate next step in the management of this patient?
This patient's worsening abdominal pain and vomiting and weight loss in the setting of chronic pancreatitis strongly suggests a diagnosis of pancreatic cancer. In the absence of jaundice, the best modality of imaging is CT with contrast which shows pancreatic mass and necrosis along with multiple liver metastasis. In such a patient the usual treatment is palliative chemo and best suppoive care. 5-FU and gemcitabine have shown to improve sho-term survival but long-term prognosis remains poor.
Whipple procedure
ERCP with stenting
Palliative chemotherapy and best suppoive care
Distal pancreatotomy and splenectomy
Integrated QBank