Author Affiliations: The Elkins Pancreas Center, Michael E. DeBakey Department of Surgery, Baylor College of Medicine (Drs Dorsey and Fisher), and Department of Pathology, Saint Luke's Episcopal Hospital (Dr Taggart), Houston, Texas.
A 54-year-old woman presented with chronic intermittent sharp midepigastric abdominal pain. She denied having jaundice or a change in her bowel function but admitted to a 5.4-kg weight loss over 3 months. Medical, surgical, family, and social histories were unremarkable. There was no history of neurofibromatosis 1. The results of physical examination and routine laboratory tests, including liver function tests, were normal. A right upper quadrant ultrasonographic and computed tomographic (CT) scan with contrast revealed a 1.4-cm enhancing lesion in the head of the pancreas without duct dilation (Figure 1).
Preoperative computed tomographic scan showing a 1.4-cm enhancing lesion in the head of the pancreas.
A. Pancreatic adenocarcinoma
B. Neuroendocrine carcinoma
C. Pancreatic schwannoma
D. Renal cell carcinoma metastatic to the pancreas
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The Rational Clinical Examination
Make the Diagnosis: Opiates and Abdominal Pain
The Rational Clinical Examination
Original Article: Do Opiates Affect the Clinical Evaluation of Patients With Acute Abdominal Pain?
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