Pruritus, nausea and vomiting are the symptoms of pancreatic cancer that may be the most distressing to patients. Several abnormalities on physical examination and laboratory testing may contribute to the diagnostic evidence of pancreatic cancer, but the most useful initial investigation is abdominal ultrasonography. Computed tomography or laparoscopy is often chosen as the next stage of investigation, depending on the clinical situation. Specialized investigations such as endoscopic retrograde cholangiopancreatography may be indicated in selected patients. Surgical resection of the pancreas using Whipple's procedure remains the mainstay of therapy, but many cases of pancreatic cancer are inoperable.
Acute appendicitis is the most common nonobstetric cause of acute abdominal pain during pregnancy.
However, the diagnosis of acute appendicitis can be challenging. Throughout pregnancy, the signs and symptoms of appendicitis may resemble obstetric complications or gynecologic conditions. The date of the patient's last menstrual period should be ascertained in all women of reproductive capability who have abdominal pain, because ectopic pregnancy is a serious consideration. Appendicitis should be considered in all pregnant women who present with fever, anorexia, and pain and tenderness of the abdomen. As the enlarging uterus displaces the appendix toward the right upper quadrant, symptoms may suggest large bowel or gall bladder pathology.