Abstract
77-year-old man with a history of obesity, hypertension, dyslipidemia, hypothyroidism, and obstructive sleep apnea presented with a 2-year history of postprandial right upper quadrant and epigastric pain. He had not had a gastrointestinal work-up previously and had received only symptomatic treatments. His right upper quadrant discomfort was associated with eating. He presented after a recurrent acute episode of severe right upper quadrant pain that lasted “several hours,” which had improved but not completely resolved. On presentation, the patient’s vital signs were within normal limits. Physical examination revealed an obese man in noacutedistresswithminimalepigastrictenderness on palpation. His medications included aspirin, calcium-vitamin D, cyanocobalamin, furosemide, levothyroxine, lisinopril, metoprolol succinate, naproxen, niacin, fish oil, omeprazole, vitamin C, and vitamin E. Initial laboratory testing including a complete blood cell count, metabolic profile, and measurement of aminotransferase, bilirubin, and amylase levels yielded normal results.
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