Postprandial Right Upper Quadrant Pain

Abstract

A 40-year-old, gravida six and para six, moderately obese Hispanic female presents to the emergency department with a 1-day history of constant epigastric and right upper quadrant (RUQ) pain. She describes the severity of the pain as a 7 out of 10. The pain began after eating fried pork. She reports that the pain also seems to affect the right side of her back near her scapula. She feels nauseated and has vomited twice. She has had similar pain, but of lesser severity and duration, several times over the past year, usually after eating fatty, spicy foods. On physical examination, her temperature is 38 °C, heart rate is 110/min, and her blood pressure is 120/80 mmHg. She has marked tenderness to palpation in the RUQ of her abdomen. After being instructed to take a breath, deep palpation of her RUQ causes her to abruptly cease inspiration due to pain. The remainder of the abdominal examination is benign. Laboratory studies are remarkable for leukocytosis of 14 × 10³/μL (normal 4.1–10.9 × 10³/μL), total bilirubin 1.0 mg/dL (0.1–1.2 mg/dl), alkaline phosphatase 70 u/L (33–131 u/L), amylase 60 u/l (30–110 u/L), and lipase 30 u/L (7–60 u/L).