Roberta I: In Pain

Gastrointestinal System


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S32_F1.jpg"}},{"insert":"\n\n\u0022Hello, doctor!\u0022 your patient says. \n\nYou smile as you recognize Roberta Moretti, the owner of the pizzeria near your house. Roberta\u0027s always been very kind to you\u2014often slipping in a free tiramisu or cheesecake into your orders.\n\n\u0022Hello! How are you doing?\u0022 you ask.\n\n\u0022I didn\u0027t want to bother you, doctor, but I\u0027ve not been feeling well,\u0022 she starts.\n"}]}


{"ops":[{"insert":"Fifty-two-year-old Roberta developed abdominal pain early this morning; this has persisted for around 5 hours now. The pain was dull and cramping in nature and located in the right upper quadrant, with radiation to the right upper back. Roberta rates the pain as 6\/10 on the pain scale. She has also felt nauseous throughout this time. No other symptoms are present.\n\nRoberta had has similar but milder episodes during the last 5 to 6 months. These episodes only lasted for an hour or less, and resolved spontaneously. She attributed them to \u0022gastritis\u0022 and thought they were just due to her \u0022getting old\u0022.\n\nRoberta has been in excellent health for all of her life. Her medical and surgical histories are unremarkable. She is not on any medications currently. Her family history is only significant for her father experiencing a \u0022heart attack\u0022 at the age of 70; he recovered and is still alive, at age 86. She does not smoke and only drinks socially. She is unmarried, has no children, and lives alone.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S32_F3.jpg"}},{"insert":"\n\nMoving on to the examination, you note that Roberta\u0027s body mass index (BMI) is 22.3. Her temperature is 98.7 \u00b0F (37.1 \u00b0C), pulse is 108 bpm, and blood pressure is 148\/86 mmHg. Her oxygen saturation is 99% on room air.\n\nExamination of the abdomen reveals tenderness and guarding in the right upper quadrant, along with a positive Murphy\u0027s sign. There is no organomegaly. There are no signs suggestive of free fluid. Cardiorespiratory examination is unremarkable.\n"}]}


{"ops":[{"insert":"History and examination done, you step back and ponder what the diagnosis might be.\n\nWhich of the following do you consider to be most likely?\n"}]}
1. Acute cholecystitis
2. Acute pancreatitis
3. Peptic ulcer disease