Right Upper Quadrant Pain, Fever, Nausea, and Vomiting

Abstract

A 40-year-old female presents with a 24-hour 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. She has also noticed dark urine today. Past medical history is negative. Physical examination reveals a temperature of 39.1 °C, a heart rate of 110 beats/min, respiratory rate of 16/min, and a blood pressure of 90/60 mmHg. Her RUQ is moderately tender to deep palpation. She has slight scleral icterus. 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 44 μ/L (5–35 μ/L), alanine aminotransferase (ALT) of 65 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.