Reference no: EM133260446

Sally a 60-year-old female, presents to the clinic today with complaints of right upper quadrant abdominal pain and nausea without vomiting. She reports a "normal" bowel movement last night. She describes the pain as "gnawing."  The pain started about 10 hours ago and has not changed. She rates the pain 6/10. She says the pain seems to penetrate through to her right scapula. The pain began about 2 hours after eating a large Tex-Mex meal. She reports a similar episode about 2 weeks ago after eating fried fish, fried potatoes, and hushpuppies at a seafood buffet. That episode only lasted a few hours and resolved on its own. She has taken tums, pepto bismol, and alka-seltzer without relief. She appears in moderate discomfort. She does not appear toxic or in acute distress.

Sally's past medical history (PMH) includes hypertension which is well controlled with Lisinopril 10mg PO QD. She does not take any other routine medication. Her surgical history consists of tonsillectomy, nasal septal repair, and wisdom teeth excision.

She does smoke 1 pack per day and has for 30 years. She does not drink alcohol. She is widowed and lives alone. She is retired. She is active in several community service groups. She has coffee with cream for breakfast every morning. She eats lunch and dinner on the go (fast food and restaurant style dining).

Vital Signs:

BP 148/88

Pulse: 88

Resp: 20

Temp:  99.7

Oxygen Saturation:  98% room air

Height:  60 inches

Weight: 158

BMI: 30.85

Pain: 6/10

Questions

• What are some of the differential diagnoses in this case?
• What other information would you seek from this patient?
• What tests or diagnostic tools would you consider in this case, if any?