Approach to upper abdominal pain Quiz: Ace Your Exams
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A 43-year-old woman comes to the emergency department for evaluation of right upper quadrant abdominal discomfort, nausea, and vomiting. The patient reports subjective fevers and yellowing of her eyes. She has a past medical history of hypertension, diabetes, hyperlipidemia, and arthritis for which she takes Naproxen daily. The patient had a laparoscopic cholecystectomy performed two years ago. She drinks 2-3 mixed drinks daily. She recently traveled to New Orleans where she had several seafood dinners. Temperature is 38.6°C (102.4°F), blood pressure is 144/66 mmHg, pulse is 97/min, respiratory rate is 16/min, and oxygen saturation is 99% on room air. On physical examination there is scleral icterus and jaundice, right upper quadrant tenderness, and hepatomegaly. The patient does not have evidence of ascites or stigmata of cirrhosis. Initial laboratory results are shown below. Which of the following tests will be most helpful for making the diagnosis?
| Laboratory value | Result |
| Complete Blood Count (CBC) | |
| Hemoglobin | 13 g/dL |
| White blood cell count (WBC) | 9,000/mm3 |
| Liver Function Tests | |
| Alkaline Phosphatase (ALP) | 300 u/L |
| Alanine aminotransferase (ALT) | 1957 u/L |
| Aspartate aminotransferase (AST) | 1786 u/L |
| Total bilirubin | 6 mg/dL |
| INR | 1.1 |
| Serum chemistry | |
| Lipase | 50 u/L |
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