Gastroenterology
Case 16: A Patient with Sudden‐Onset Upper Abdominal Pain
CASE
A 48‐year‐old woman presents with severe upper abdominal pain. This was of sudden onset after eating a meal out at a restaurant. It is situated in the epigastrium and right upper quadrant (RUQ). The pain is coming in waves (i.e. colicky) causing intense nausea, sweating and retching. She has had one or two previous episodes like this but none quite as intense or as prolonged.
On examination the patient is obviously in pain with a tachycardia of 110 beats/min. Her BP is 130/85 mmHg and her temperature is 37.3°C. Abdominal examination reveals marked right upper quadrant tenderness. There is no palpable organomegaly and no masses.
Blood tests showed:
Hb 13.6 g/dL WCC 12.2 × 109/L Platelets 168 × 109/L Plasma viscosity 1.56 cP Na 140 mmol/L K 4.2 mmol/L Urea 3.8 mmol/L Creatinine 89 µmol/L Albumin 42 g/L Bilirubin 12 µmol/L ALP 150 U/L AST 24 U/L
QUESTION 1
Your score this session: 0 of 0
The best next investigation would be: