Framework for a Solitary Pancreatic Mass
- Please see the previously posted pearls on metabolic alkalosis: https://ucsfmed.wordpress.com/2016/06/27/moffitt-am-report-pearls-62716-acid-base-disorders-and-metabolic-alkalosis/
- Key points: – Think about losses of H+ (GI or renal), transcellular shift of H+, contraction alkalosis, and too much bicarb intake! – Useful test to send: Urine Chloride!
- Urine Cl < 25: saline responsive! Given volume to these patients : Examples include vomiting, diuretic use, contraction alkalosis
- Urine Cl > 40: saline unresponsive
: Examples include renal losses, electrolyte derangements
: If patient is saline unresponsive, look at their BP
–> Low/normal P: severe hypokalemia, Bartter’s
–> elevated BP: hyperaldosteronism, hypercortisolism
Use of CA 19-9 in Treatment of Pancreatic Adenocarcinoma
- There is a correlation between duration of patient survival and decline in level of CA 19-9 in patients receiving chemotherapy. However, there is much debate on the reliability of using CA 19-9 as a surrogate for survival.
- ASCO (American Society of Clinical Oncology): “data is insufficient” to use serum 19-9 levels alone for monitoring response to treatment> : Recommendation is to measure CA 19-9 levels at start of treatment and then every 1-3 months during therapy for advanced pancreatic cancer. Suspected disease progression based upon rising CA 19-9 levels should be confirmed radiographically!