A 43-year-old Arabic woman presented with dyspepsia, vomiting, and weight loss for one month. On examination, she had evident weight loss but no other abnormalities. She was diagnosed with pancreatic head cancer and sent to surgery for bypass surgery and a histological diagnosis. This case demonstrates that dyspepsia with alarm features like weight loss and anemia in those over 45 should prompt consideration of pancreatobiliary causes and appropriate imaging if upper GI pathology is not found.

1. Case of the week: GOO Dr. Mohamed Shekhani.

2. History: 43 years old Arabic woman presented with dyspesia, vomiting & weight loss for the last month. O/E: evident weight loss, no pallor or jaundice, no LAD, No clubbing, normal chest & heart & abdomen soft with no organomegaly.

15. Diagnosis: Pancreatic head cancer. Sent to surgeon for bypass surgery & histological diagnosis.

16. Lessons: Dyspepsia with alarm features as anorexia,weight loss,anemia, H/M, >45 is indication for endoscopy. If you don’t find a clear upper GIT pathology explaining the symptoms we should think of pancreatobiliary pathology& send for appropriate imaging.

17. Another case: Elderly woman with epigastric pain,anorexia,weight loss. OGD normal.

18. EUS:

19. Encroaching (to advance beyond proper or former limits: desert encroaching upon grassland) on the portal vein making it inoperable :

20. 60 years old female with DM,presented with dyspepsia,anorexia, weight loss

22. EMR done: ulcer after the EMR

24. After ulcer healing: remnant lesion

25. After ulcer healing: remnant lesion

26. After ulcer healing: remnant lesion

27. After ulcer healing: remnant lesion new biopsies taken; further actions?