Case Studies

Case 7: A 60-year-old man with carcinoma head of pancreas (Part 9 The hepato-biliary system)

Mr Lewis, a 60-year-old, complains of being lethargic, tired and just doesn't know what is wrong. He goes to see his local GP, who gives him a blood test, but nothing really comes up. A couple of months later he returns to his GP. By this time, his urine is bright orange and his stools are pale in colour. He browses through the website and learns that these are typical symptoms of pancreatic cancer but his GP still doesn't recognize the disease.

By his next visit, his skin and eyes have turned yellow with jaundice. His GP looks shocked and refers him immediately to the local hospital. He has an ultrasound and a tumour in his pancreas is discovered. He and his wife are shocked to hear the news from the consultant, who also informs him that he needs to come into hospital immediately for a special surgery called Whipple's procedure.

• 1. Explain why Mr Lewis's urine was bright orange, his stools were pale in colour and his skin and eyes have turned yellow in colour. Consider the flow of bile though the biliary tract.

• 2. Discuss other possible investigations that may be carried out to confirm diagnosis.

• 3. Discuss the pre-operative preparation of Mr Lewis for theatre.

• 4. Discuss the postoperative care of Mr Lewis on return to the ward following Whipple's procedure.