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Have nausea, discomfort below sternum and fever. Blood test normal. Ultrasound showed a tortuous splenic artery. Mean pancreatic cancer?

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General & Family Physician
Practicing since : 2009
Answered : 3041 Questions
i have nausea , discomfort right below sternum, low grade fever daily. it has been going on everyday for 5 months. all blood tests normal, stool cultures normal, blood cultures normal, XXXXXXX test normal, no autoimmune diseases, havenot traveled, negative mri of abdomen, negative ct of abdomen and pelvis, ultrasound showed a markedly tortuous splenic artery adjacent to the pancreatic head with no flow on doppler. does this mean i have pancreatic cancer? i have not had a ca-19-9 test.
Posted Wed, 26 Jun 2013 in Digestion and Bowels
Answered by Dr. Luchuo Engelbert Bain 1 hour later
Hi and thanks for the query,

I will start by saying it s by no way the classical presentation of pancreatic cancer. I do not think you need to bother about pancreatic cancer at this point in time. The pain in pancreatic cancer is generally more severe and is characterized by severe wasting and weight loss, pain when food is taken in and at times raised blood glucose levels. remember the pancreas secretes insulin, an enzyme needed to reduce blood glucose. I honestly do not think the clinical picture is suggestive of pancreatic cancer. However, it is still worth investigation.

From your description, a chest X XXXXXXX must have been done which was negative for sure. I find it very appropriate for prescribing Omeprazole in this case. It could be very interesting doing a fibroscopy o exclude any gastric ulcers or tumour.

From the tests already run, the low grade fever you describe should then be considered a Pyrexia of Unknown Origin. Sarcoidosis, Tuberculosis (extrapulmonary), Lyphomas, Systemic diseases (SLE, Vasculitis must be carefully be considered, testing and excluded. It would interesting to know if you have done an HIV test or not? If not, it might be worth doing.

I suggest you book an appointment with an internist who can work with an infectiologist and get these options reviewed.

Knowing exactly when you started experiencing these symptoms and how they have been evolving is very important. IT MUST NOT BE LOST TO SIGHT THAT THESE MIGHT SIMPLY BE ASSOCIATED WITH A MENOPAUSAL SYNDROME.

Doing an abdominal ultrasound and testing for CA 19-9 for pancreatic cancer might help. But I would not love you to be worried with respect to pancreatic cancer as of now. It is possible, but a VERY RARE POSSIBILITY given thus clinical scenario.

Thanks and hope this helps as i wish you the best of health. Do not hesitate asking further questions if need be,

Bain LE, MD.

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