The physician’s assistant I was working with in the emergency department had gone to see a patient for a complaint of itching and told me that that something didn’t feel right. Brian had been having issues with itching for the past several weeks and neither Benadryl nor a steroid prescription from his family doctor had helped. He had a bad reaction to poison ivy in the past and figured he had come into contact with it again, even though he hadn’t done any recent yard work.
My physician assistant ordered labs and a CT scan of Brian’s abdomen because she had noticed a slight yellowing of his skin and eyes. Brian’s wife had not noticed his yellow skin until the PA asked her if his skin looked normal to her. He had some marks from scratching but there was no rash to explain his itching. His abdomen was soft and there were no areas that were tender to the touch.
We ordered the CT scan of his abdomen to help determine why he was jaundiced. Normally the liver releases bile through the common bile duct into the intestines, where it helps with digestion by breaking down fat. When the common bile duct is blocked, bile cannot get to the intestines and subsequently bilirubin builds up in the body. This can cause itching, which was Brian’s first symptom.
Pancreatic cancer is hard to detect in its early stages when it is most curable, as it often doesn’t cause symptoms until it has spread to other organs. The radiologist didn't see any evidence of spread to his liver or other organs, so I was hopeful we had caught it early in Brian’s case and that he would have a good outcome with available treatments.
Cool cool, something new for me to lose sleep over.