History
A 62-year-old gentleman is admitted for a chest infection. He has a past history of nasopharyngeal carcinoma and pulmonary tuberculosis. A chest computed tomography scan is performed. An incidental finding of a cystic pancreatic dilatation is noted. He denies any abdominal pain, weight loss or change in bowel habit.
•Afebrile, pulse 80 bpm, BP 115/78mmHg, SaO2 96% on RA.
•Hydration is satisfactory.
•Examination of the hands reveals no clubbing and normal-appearing palmar creases.
•Head and neck examination is unremarkable.
•Cardiovascular: HS dual, no murmur.
•His chest is clear on auscultation.
•Abdominal examination reveals a soft, non-tender abdomen, with no definite mass palpable.
•No signs of oedema.
Investigations
•CBC:
–WBC 5.8 x 109/L;
–haemoglobin 11.8g/dL;
–platelets 283 x 109/L.
•ALP 138 IU/L.
•ALT 16 IU/L.
•Bilirubin 4μmol/L.
•Amylase 81 IU/L.
•CA 19.9 is 457 kIU/L (reference range is <18).
What would you do next?
A formal CT of the abdomen and pelvis with contrast (Figure 13.1).
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