Your patient is a 52-year-old male with a history of smoking and alcohol abuse.

Your patient is a 52-year-old male with a history of smoking and alcohol abuse. He presents to the ED with complaints of “my skin looks yellow, my stomach hurts, and I feel nauseous”. He is taken to CT and a tumor near the pancreas is observed. It appears to be blocking the common bile duct. Develop a plan of care for the patient.

ANSWER
Plan of Care for 52-year-old Male with Jaundice, Abdominal Pain, and Pancreatic Tumor

Initial Assessment:

History: Gather detailed information about the patient’s medical history, including smoking and alcohol abuse, family history, current medications, and any allergies.

Physical Examination: Conduct a thorough physical examination, paying particular attention to the abdomen, including palpation for tenderness or masses.

Laboratory Tests: Order appropriate laboratory tests, including liver function tests (LFTs) to assess liver function and bilirubin levels, complete blood count (CBC) to evaluate for any abnormalities, and coagulation tests to assess clotting ability.

Imaging Studies: Review the CT scan results to determine the exact location and size of the pancreatic tumor and its impact on the bile duct.

Diagnosis:

Based on the clinical presentation and imaging findings, the patient is likely suffering from obstructive jaundice caused by a pancreatic tumor. The tumor is compressing the common bile duct, preventing bile from flowing from the liver and gallbladder to the small intestine. This leads to the buildup of bilirubin in the blood, causing jaundice, and can also cause abdominal pain, nausea, and vomiting.

Treatment Plan:

Medical Management:

Obstructive Jaundice Management: The goal is to relieve the obstruction and reduce bilirubin levels. This may involve stenting or drainage procedures to bypass the blocked bile duct.

Pain Management: Administer appropriate pain medication to manage the patient’s abdominal pain.

Nutrition Management: Implement a nutritional plan to ensure adequate intake of calories, fluids, and essential nutrients. This may involve oral supplements or enteral nutrition if oral intake is insufficient.

Surgical Management:

Tumor Resection: If the tumor is deemed resectable, surgical removal may be considered to eliminate the source of the obstruction and address the underlying malignancy.
Further Evaluation:

Oncological Evaluation: Refer the patient to an oncologist for further evaluation and management of the pancreatic tumor. This may involve additional imaging studies, biopsy, and discussion of treatment options, including chemotherapy and radiation therapy.
Monitoring and Follow-up:

Close Monitoring: Closely monitor the patient’s vital signs, liver function tests, pain levels, and nutritional status.

Regular Follow-up: Schedule regular follow-up appointments to assess the patient’s progress, monitor treatment response, and address any emerging concerns.

Patient Education:

Provide education about the patient’s condition, including the cause of jaundice, treatment options, and potential side effects of medications or procedures.

Encourage lifestyle modifications, such as smoking cessation and alcohol abstinence, to promote overall health and improve treatment outcomes.

Emphasize the importance of regular follow-up appointments and adherence to the treatment plan.

Offer support and resources to help the patient cope with the emotional and psychological impact of the diagnosis.