Right Upper Quadrant Pain

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of RUQ pain

Onset was ‍gradualsudden, started ‍whileafter ‍

Radiation ‍none to ‍

Rated at ‍012345678910 / 10 ‍

Described as ‍crampingburning

Pattern ‍persistentintermittent

Episodes last for ‍ ‍, recur ‍ times per ‍

Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills

‍jaundice

‍change in stool color

‍change in urine color

‍bloating

‍flatulence

‍heartburn

‍dyspepsia

‍diarrhea, ‍ episodes ‍per day, ‍

‍constipation

‍weight loss, ‍ ‍lbskg over ‍ ‍weeksmonths, ‍unintentionalintentional

‍chest pain, ‍retrosternal, ‍aching, ‍on exertionat restwith deep breath, ‍mild

‍shortness of breath



Contributing factors:

‍high-fat diet

‍heavy alcohol consumption

no history of: ‍gallstones, ‍hepatitis, ‍liver disease, ‍peptic ulcer disease, ‍pancreatitis, ‍previous abdominal surgeries

no use of: ‍NSAIDs, ‍anticoagulants

no family history of: ‍gallstones





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Anorectal: DRE ‍normal, prostate ‍normal, ‍blood, ‍mass, anus ‍

Pelvic: external genitalia ‍normal, vagina ‍normal, cervix ‍normal, uterus ‍normal, adnexa ‍normal, ‍cervical motion tenderness

Genital: penis ‍normal, testes and epididymis ‍normal, ‍inguinal hernia





ASSESSMENT:

‍Gallstones ‍likelysuspectedpossible

DDx: gallstones, biliary colic, cholecystitis, hepatitis, liver abscess, gastritis, peptic ulcer disease, right lower lobe pneumonia, hepatic metastasis, pyelonephritis, renal stones, rib fracture, herpes zoster, pancreatitis, hepatic congestion due to heart failure, appendicitis with atypical presentation





PLAN:

Investigations:

- Blood work: ‍CBC, ‍CRP, ‍lytes, ‍creatinine, ‍glucose, ‍LFTs, ‍lipase, ‍ß-hCG, ‍troponin, ‍H. pylori antibodies

- Urinalysis, urine culture

- Abdominal X-ray

- Abdominal ultrasound

- CT scan of abdomen and pelvis

- HIDA scan

- MRCP

- ERCP

- ECG

- Chest X-ray

Treatments:

- ‍Analgesics

- ‍Opioiods

- ‍Antiemetics

- ‍Antibiotics

Further care:

- Referral to gastroenterologist

- Referral to general surgeon

- Follow-up in ‍ ‍daysweeks

- Return if pain worsens or if new symptoms develop such as fever, jaundice, or changes in stool color