A Simple Case of Abdominal Pain in the ED?

​A previously healthy 17-year-old girl presented to the ED with one month of intermittent, burning epigastric pain associated with nausea and vomiting. Pain was worsened by spicy, greasy foods, and alleviated by sparkling water. She said she came to the ED because the pain had persisted for a while and was interfering with her life. The patient denied fevers, recent travel, or a change in bowel movements. She admitted to traveling to Nicaragua many times in her life and to an unintentional 20-pound weight gain over the past year.​Vitals at presentation were a heart rate of 83 bpm, temperature of 36.6°C, blood pressure of 114/62 mm Hg, and respiratory rate of 20 bpm. Physical exam was significant only for a slightly enlarged nontender thyroid gland and mild epigastric and right upper quadrant tenderness to palpation. The RUQ tenderness on exam prompted a bedside ultrasound to explore for cholelithiasis, choledocolithiasis, cholecystitis, and hepatitis. It showed a gallbladder with a Phrygian cap that appeared normal and a white hyperechoic lesion in the liver that prompted an abdominal ultrasound by an ultrasound tech and a reading by a radiologist.The patient received one dose of antacids for her abdominal pain, which she said resolved her symptoms. The ultrasound revealed a normal gallbladder and a liver mass characterized as an ill-marginated 3.5 x 5.3 cm echogenic focus in the left lobe of the liver with peripheral hypoechogenicity with internal central vascularity sh...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research