Cancer of the Pancreas An Unfolding Case Study

Cancer of the Pancreas An Unfolding Case Study of my Father MJS By: Kimberly Silver-Dunker

Case Study - MJS • • • 48 year old admit to ED Weight loss of 40 lbs in 6 weeks Presents with Jaundice, Elevated AST, ALT Total Billirubin 9. 8 Elevated Amylase & Lipase C/O RUQ pain radiating all over C/O Severe itching (puritis) C/O fatty stools, liquid consistency PMH: None…healthy, ideal body weight, no smoking or alcoholic drinking

Q&A • Is this a gall bladder issue? • What are the clinical manifestations or assessment findings? What are the diagnostics? What are the treatment options? • What is the nursing care involved?

Initial Diagnosis To Start Video Click Here

Case Study - MJS • • • MJS underwent an ERCP? Current Total Billirubin 14. 5 How would you prep this patient? What are the significant Findings? What interventions can be done during this procedure? • Major complications associated with an ERCP?

ERCP Click Here to Start Video • Endoscopic Retrograde Cholangiopancreatography (ERCP) • Important Diagnostic Test

Endoscopic Retrograde Cholangiopancreatography (ERCP)

Case Study MJS • • After ABD CT and ERCP MJS has positive obstruction in the biliary tract Stent is placed to drain the excessive bile Current Billirubin is 18. 6, increased Amylase & Lipase, as well as LFT’s • Pt continues to complain of “Severe Puritis” multiple skin abrasions on his arms and legs • C/O Anorexia with continued weight loss

Case Study MJS • MJS has ruled in for pancreatic CA (primarily in the head of the pancreas) • He is started on TPN for nutrition • Chemo and Radiation • Lotion for his itchy skin and arixtra for the puritis • Pre operative for Whipple Surgery

CA 19 -9 Start Video Click Here

A risk factor associated with cancer of the pancreas is A. B. C. D. Alcohol Intake Cigarette Smoking Exposure to asbestos Increased dietary intake of milk and milk products

B Cigarette smoking, high-fat diet, diabetes. Alcohol intake is more associated with pancreatitis

Signs and Symptoms? PAIN - earliest and most common symptom • weight loss • G. I. Upset • Jaundice • Pruritus

Treatment • Neither radiation or chemotherapy is effective -- extend life one year only • Surgical: Whipple Procedure need to take pancreatic enzymes for life ie. Viokase Allen Oldfather Whipple (1881 -1963

Click Here to Start Video Chemotherapy A patient’s experience with Chemo & Radiation “Rough Times”

pancreatico- duodenectomy

Click Here to Start Video Pre-Op Surgery How did they prepare MJS for a 16 hour + Whipple Surgery?

Click Here to Start Video Post-Op Complications Paralytic Illeus GI Complications Vomiting & Dehdration

Click here to start video Post-Op Ileus & Drain Management of Patient Complications- Drain #2

Case Study – MJS • MJS underwent a successful whipple procedure • Biliary Liver diversion completed • Head of the Pancreas removed and connected to the duodenum. • MJS remains on pancreatic enzymes and TPN until nutrition heals • T tube in place to drain excess bile in the short term • JP drain to bulb suction • He survived three years post diagnosis of Pancreatic CA • The videos which you have watched were taken 4 months before he died. He was very weak and tired at that time.

This Case is Dedicated to my Father! Love and miss you dad! Your story keeps on giving!