45 Year old man comes to the emergency department because of a 4.5 kg weight loss in the past 3 months. He has a history of alcohol abuse and multiple past admissions for epigastric pain. He has symptoms of upper abdominal pain raidiating to his back and bulky 'greasy' stools. Labratory studies show elevated PT and PTT. Which of the following is the most likely underlying cause of his disease.
A) Adenocarcinoma arising from the pancreatic epithelium
B) Carcinoma of the intrahepatic bile ducts
C) Fobrosis of the intrahepatic and extrahepatic bile ducts
D) Gastric outlet obstruction
E) Insufficient secretion of pancreatic enzymes
I don't know why but I just cant make the connection of this scenario being an insufficient lipase issue with his symptoms. His weight loss and fat malabsorption seems like it would be caused by a bile duct obstruction due to carcinoma in head of the pancreas. He is also currently having an attack as the question says (pain radiating to his back etc) which would imply a pancreatitis attack and thus diagnostically they would check for his ELEVATED enzymes.
What am I missing here? The answer explanation on the site for this question is really not helpful.
I'll go with E, malabsorption --> impaired absorption of fat soluble vitamins (in this case K, which is messing with his PT and PTT) and bulky greasy stools is steatorrhea
It's not pancreatic cancer because the most common sign is Painless Jaundice, and since this guy has no elevation of AST or ALT or elevation of Bilirubin (direct or indirect) for me that rules out bile duct or liver problems.
That's how I would answer this one...in my head at least...what's the correct answer?
yeah i think E as well coz if they wanted us to think that it was cancer, theyd probably mention the enzymes or something more. also the weight loss i think can easily be attributed to the malabsorption...So whats the consensus going to be like?
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