Fatigue, Weight Loss, and Abdominal Cramping in a 70-Year-Old Man

Tomislav Dragovich, MD, PhD; Shailja B. Amin, PA-C


December 19, 2014

Physical Examination and Work-up

At presentation, the patient appears to be in no acute distress. His vital signs include blood pressure of 142/80 mm Hg, heart rate of 72 beats/min, temperature of 98.2°F, respiration rate of 18 breaths/min, height of 179 cm, and weight of 84 kg. Examination of the head, ears, nose, and throat is unremarkable. The neck is supple, with no evidence of an enlarged thyroid gland. Chest expansions are symmetrical, with clear pulmonary auscultations. The cardiac rhythm is regular, with no murmurs or gallops identified.

The abdomen is soft and nontender. Generalized distention is noted upon palpation of the abdomen. The liver edge is palpable 2 cm below the right costal margin. The extremities show no evidence of cyanosis or edema.

Laboratory analysis shows a white blood cell count of 6100 cells/mL (normal range, 4000-11,000 cells/mL), a hemoglobin level of 11.9 g/dL (normal range, 13-17.5 g/dL), and a platelet count of 176,000 cells/mL (normal range, 130,000-450,000 cells/mL). The complete metabolic panel is within normal limits.

Further work-up included CT of the abdomen and pelvis with contrast, which revealed a 3.7-cm mass within the body of the pancreas. A moderate amount of ascites was present. The patient was referred for an upper endoscopic ultrasonography (EUS)-guided biopsy of the pancreatic mass.


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