Abstract

A 61-year-old woman whose medical history was notable for hypertension and type 2 diabetes reported a two-day history of increasing dull pain in the right flank and nonbloody, bilious vomiting. Physical examination revealed no abdominal masses, costovertebral-angle tenderness, or peripheral edema. Laboratory evaluation revealed normal serum creatinine levels (1.0 mg per deciliter [88.4 μmol per liter]); the presence of hyperlipidemia (total cholesterol level, 938 mg per deciliter [24.3 mmol per liter]; triglyceride level, 811 mg per deciliter [9.2 mmol per liter]; and high-density lipoprotein cholesterol level, 44 mg per deciliter [1.1 mmol per liter]); low total-protein and albumin levels (3.9 . . .

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