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Abstract: The patient in this case is an 88-year-old woman who had upper abdominal discomfort after eating 2 months ago, but did not seek immediate medical attention.
Basic information】Female, 88 years old
Disease Type】Pancreatic cancer
Hospital】The First Hospital of China Medical University
Date of consultation】March 2022
Treatment plan】Surgical treatment (hepatic artery embolization, perfusion chemotherapy) + oral medications (omeprazole magnesium enteric tablets, domperidone tablets, morphine hydrochloride extended-release tablets)
[Treatment period] 2 weeks of hospitalization, long-term follow-up
Treatment effect] Initial control of the disease
I. Initial consultation
The patient is an 88-year-old female, complaining of epigastric burning pain for more than 2 months, and the pain mostly occurs after eating, and is accompanied by abdominal distension, belching, loss of appetite, fatigue and other uncomfortable symptoms, but no nausea, vomiting, fever, no special treatment outside the hospital, for further diagnosis and treatment came to our hospital, the patient is clear on admission, but poor in spirit, and the abdomen is flat and soft, no pressure pain and rebound pain, intestinal The abdomen was flat and soft, without pressure pain and rebound pain, and the bowel sounds were normal. There was no edema in both lower limbs. After explaining the situation to the patient and his family, he was admitted to the hospital for treatment with the cause of abdominal pain to be investigated. The patient had a history of frozen shoulder and ankylosing spondylitis, cataract surgery and meniscal trauma of the knee.
II. Treatment history
After admission, the patient was given omeprazole magnesium enteric solution tablets for acid suppression treatment, and female tumor marker examination and 3D-CT for hepatobiliary-pancreatic-splenic enhancement, which showed heterogeneous hypodensity of the pancreas and mild heterogeneous enhancement on the enhancement scan, with the adjacent left gastric artery and splenic artery showing tortuous and slender shape and intermittent, and the wall of the duct was rough. The peripancreatic fatty space was not clear, the mesentery was thickened, and the pancreatic duct in the tail of the pancreas was dilated. The pancreatic malignant tumor was considered to involve the left gastric artery, splenic artery and multiple metastases in the liver, retroperitoneum and lymph nodes in the right cardiodiaphragmatic angle. Further puncture biopsy was performed, and pathological examination diagnosed pancreatic adenocarcinoma with stage T4N2M1, indicating that the tumor involved the celiac trunk, superior mesenteric artery or common hepatic artery; there were already distant metastases and multiple lymph node metastases, and hepatic artery embolization and perfusion chemotherapy were performed with the patient and his family, and the patient’s vital signs were continuously monitored after surgery, and he was hospitalized for a total of 2 weeks.
III. Treatment effect
After drug treatment and surgery, the patient reported that her abdominal pain was reduced, her sleep was basically unaffected, and she had no nausea, vomiting, fever, and other uncomfortable symptoms, and her belching, loss of appetite, and fatigue before treatment were also improved, indicating that the treatment plan was effective for the patient and could relieve her uncomfortable symptoms. After 2 weeks of treatment, the patient’s abdominal CT was repeated and showed no significant growth of the tumor, which further indicated that the disease was stable and under initial control. The patient was advised to be discharged from the hospital for convalescence and to seek medical treatment if there was any discomfort.
IV. Notes
After 2 weeks of in-hospital treatment, the patient’s condition improved, the discomfort subsided, and he was obviously happier than before he was admitted to the hospital, and I felt very pleased. I prescribed omeprazole magnesium enteric tablets, domperidone tablets and morphine hydrochloride extended-release tablets, and advised the patient’s family to supervise the patient to take them on time after discharge; at the same time, pay attention to outpatient review and regular review of abdominal CT to monitor the treatment effect; in addition, patients should also pay attention to rest after discharge, and should not stop the pain medication without permission, so as not to affect sleep and daily life; especially the elderly have poor resistance, and should also add appropriate according to the weather conditions In particular, elderly people have poor resistance, so they should add clothes appropriately according to the weather condition to avoid getting cold and infection, which will aggravate the primary disease and further increase the difficulty of treatment.
V. Personal insight
Most of the patients with pancreatic cancer are similar to the patient in this article, and the mortality rate is high because the disease has already developed to a serious level when diagnosed. discomfort symptoms and improve their quality of life.