Right Upper Quadrant Pain, Fever, Nausea, and Vomiting

Abstract

A 40-year-old female presents with a 24 h history of right upper quadrant (RUQ) and epigastric pain, associated with nausea and vomiting. She has had similar pain in the past, particularly after eating greasy foods. According to her family, over the last few hours, the patient has become slightly confused. Past medical history is negative. Physical examination reveals a temperature of 102.5 °F, a heart rate of 110 beats/min, respiratory rate of 16/min, and a blood pressure of 90/60 mmHg. She is moderately tender in the RUQ to deep palpation. She has slight scleral icterus. She has noted dark-colored urine. The remainder of her abdominal exam is negative. Laboratory examination is significant for a white blood count of 15 × 103/μL (normal 4.1–10.9 × 103/μL), a total bilirubin of 4.0 mg/dl (0.1–1.2 mg/dl), alkaline phosphatase (AP) of 350 μ/L (33–131 μ/L), aspartate aminotransferase (AST) of 300 μ/L (5–35 μ/L) and alanine aminotransferase (ALT) of 280 μ/L (7–56 μ/L), gamma-glutamyl transpeptidase (GGT) of 330 μ/L (8–88 μ/L), and an amylase of 100 μ/L (30–110 μ/L). Urine is positive for bilirubin.