Dr. Erika Kube
A doctor’s assistant I worked with in the emergency department went to see a patient complaining of itching and told me something was wrong. He had had a bad reaction to poison ivy in the past and was exposed to poison ivy again despite not doing any yard work recently. I thought.
Brian said he had been a little tired the last few weeks and had taken a rare nap for him. He thought his stomach was upset because of the medicine he was taking. His wife told him he needed to come to the emergency department for her evaluation.
My Physician Assistant (PA) noticed slight yellowing of Brian’s skin and eyes, so ordered a lab and CT scan of his abdomen. Brian’s wife didn’t notice Brian’s yellow skin until PA asked her if his skin looked normal. He had some scratch marks, but no rash to explain the itchiness.
I went to see Brian and had the same feeling as my PA. I was hoping our suspicions were wrong. Brian’s wife was clearly worried about what we would find. I explained that I was waiting for his exam and his CT scan and would come back when I had the results to discuss.
A CT scan of his abdomen was ordered to determine the cause of his jaundice. Normally, the liver releases bile (which contains bilirubin) through the common bile duct into the intestine where it breaks down fats and aids digestion. When the common bile duct is blocked, bile cannot reach the intestines and bilirubin accumulates in the body. This can cause itching, which is Brian’s first symptom.
After seeing a few more patients, I got a call from the lab. His liver tests were abnormal, including elevated bilirubin levels, which explained the yellowing of his skin. I was told that there was a mass right next to it, and it was very likely that it was pancreatic cancer. A clot was compressing the common bile duct, which explained why his bilirubin level was high.
Pancreatic cancer is difficult to detect in its early stages, when it is most curable, because it often does not cause symptoms until it has spread to other organs. Having seen no evidence of metastasis to his liver or other organs, the radiologists discovered it early in Bryan’s case and hoped he would do well with available treatments. I was hoping
Pancreatic cancer has several modifiable risk factors, including smoking, obesity, diabetes, exposure to certain chemicals, and chronic pancreatitis, an inflammation of the pancreas. Other risk factors that cannot be changed include age, family history, gender, race, and some genetic conditions. Research is ongoing into other possible risk factors such as diet, alcohol use and even lack of physical activity. He knew no other family members with a history of pancreatic cancer and had no apparent risk factors for developing pancreatic cancer.
I sat down with Brian and his wife to discuss his results. His wife had tears in his eyes when I entered. Brian was quiet and he didn’t say much when I went over everything, but he asked me if this was a death sentence. I could not give him an exact number, but explained that I hoped the odds would be in his favor as there was no evidence of the cancer spreading. , also explained that there are new treatments on the horizon.
I admitted Brian to the hospital so that he could meet with an oncologist and a surgeon to confirm the diagnosis and determine the best treatment plan, possibly including surgery and chemotherapy. As I left the room, I shook Brian’s hand and hugged his wife.
Dr. Erika Kube is an emergency physician working for Central Ohio Emergency Services and OhioHealth.[email protected]
