1. Laboratory Work-up Unica Francisco

2. LABORATORY WORK-UP

3. 8.16.11Reference Direct Bilirubin223.73.4-13.0 Indirect Bilirubin95.70-18 Total Bilirubin319.48.5-23.6 SGPT/ALT201.900-45 SGOT/AST220.200-35 ALP507.4830-120

5. 8.16.11Reference SGPT/ALT201.900-45 SGOT/AST220.200-35 ALP507.4830-120 IMAGING STUDIESRESULTS ABDOMINAL ULTRASOUNDNormal sized liver with mild fatty changes Ill defined hypoechoic structure at the region of the peripancreatic head with secondary dilation of the intra and extrahepatic and pancreatic ducts. These findings are worrisome for periampullary growth. CT/ERCP was recommended for confirmation

6. Ultrasound Findings Pancreatic head Intrahepatic duct dilatation Dilated pancreatic duct Extrahepatic duct dilatation

7. TUMOR MARKERS

8. CA 19-9 CA 19-9 antigen is a sialylated oligosaccharide that is most commonly found on circulating mucins in cancer patients. It can be elevated in acute or chronic biliary disease. Patients with pancreatic carcinoma, 75-85% have elevated CA 19-9 levels. CA 19-9 value of greater than 100 U/mL is highly specific for malignancy, usually pancreatic.

9. CEA Carcinoembryonic antigen (CEA) is a high– molecular weight glycoprotein found normally in fetal tissues. It has commonly been used as a tumor marker in other gastrointestinal malignancies. The reference range is less than or equal to 2.5 mg/mL. Only 40-45% of patients with pancreatic carcinoma have elevated CEA levels.