Sudden-onset right upper quadrant abdominal pain

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Reference no: EM133764842

Question

A 50-year-old woman presents with sudden-onset right upper quadrant abdominal pain. She says her symptoms started 6 hours ago, after she had dinner. The pain is described as cramping and radiating to her shoulders. She had similar episodes in the past, but they were less severe and resolved with over-the-counter analgesics. Past medical history is significant for hypertension and coronary artery disease, for which she had a drug-eluting coronary artery stent placed one week ago. Current medications include aspirin, ticagrelor, hydrochlorothiazide, and a fibrate. Vital signs show: temperature 37.7°C (99.9°F), blood pressure 110/80 mm Hg, heart rate 80/min, and respiratory rate 15/min. Abdominal exam reveals severe right upper quadrant tenderness, and she catches her breath when palpated deeply just below the right costal margin. A surgeon is consulted and determines her to be unfit for surgical intervention, due to high risk of bleeding from the dual antiplatelet therapy she is on for her recent coronary stent. Interventional radiology is consulted for percutaneous cholecystostomy tube placement, but comes to the same conclusion regarding the bleeding risk from her home medications. A cardiologist is consulted and states that the dual antiplatelet therapy should not be held for any surgery or interventional radiology.

Reference no: EM133764842

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