Carcinoma of pancreas associated with

.Ampullary tumours mainly present with jaundice and weight loss.b. Carcinoma of head and neck region present with weight loss and jaundice. c. Cystadenocarcinoma of pancreas present with pain, weight loss . * Silvery stool (due to mixing of undigested fat with metabolised blood derived from the ooze of periampullary growth). * Loss of appetite and weight. * Scratch marks on the back. * Migratory superficial thrombophlebitis--Trousseau's sign (10%) is due to release of platelet aggregating factors from the tumour or its necrotic material. (Trousseau himself died of carcinoma pancreas who had migrating thrombophlebitis.) * Ascites. * Left supraclavicular palpable lymph node. * Secondaries in rectovesical pouch (Blumer's shelf). * Gall bladder may be palpable which is nontender, soft, globular, smooth, moving with respiration, mobile horizontally, dull on percussion. (30% in carcinoma head of pancreas; 50% in periampullary carcinoma). Courvoisier law ours gall bladder enlargement. * Liver is enlarged, smooth, firm, nontender, due to dilated bile filled biliary radicles--Hydrohepatosis. Liver can show multiple hard nodules due to secondaries. * Cystadenocarcinoma of pancreas can present with mass in epigastric region, which is nonmobile, not moving with respiration, smooth, soft, nontender. * Splenic vein thrombosis with splenomegaly (10%) can occur. ref:SRB&;S manual of surgery,ed 3,pg no 632