Whipple procedure indicationsDownloads

A 62-year-old woman referred to the cardiology clinic for the evaluation of fatigue and dyspnea for 4 months. She also has loose stools (2–4 per day), palpitations, and non-pitting edema up to her mid-calf. On examination, vital signs are unremarkable, but she appears to be flushed with mild bilateral wheezes can be heard on chest auscultation. Cardiovascular examination reveals a grade 2/6 holosystolic murmur at the left mid-sternal area, which is louder during inspiration. Basic laboratory investigations are unremarkable. Echocardiography reveals moderate to severe right ventricular dilatation with severe right ventricular systolic dysfunction. A CT of the chest and abdomen reveals a solid, non-obstructing 2 cm mass in the small intestine and a solid 1.5 cm mass in the liver. What is the most likely cause of her symptoms?

A 55-year-old female presents to the emergency room complaining of severe abdominal pain. She reports a six-month history of worsening dull mid-epigastric pain that she had attributed to stress at work. She has lost fifteen pounds over that time. She also reports that her stools have become bulky, foul-smelling, and greasy. Over the past few days, her abdominal pain acutely worsened and seemed to radiate to her back. She also developed mild pruritus and yellowing of her skin. Her temperature is 101°F (38.3°C), blood pressure is 145/85 mmHg, pulse is 110/min, and respirations are 20/min. On examination, her skin appears yellowed and she is tender to palpation in her mid-epigastrium and right upper quadrant. She is subsequently sent for imaging. If a mass is identified, what would be the most likely location of the mass?