severe right-upper-quadrant pain

A patient goes to the emergency room complaining of severe right-upper-quadrant pain . She reports that the pain has come and gone for the last several days. In the last few hours (since eating a fried chicken dinner), the pain has become excruciating. What problem do you think that this patient may be experiencing? What could the doctor do to confirm the diagnosis?

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I believe this woman may be suffering from cholelithiasis (gallbladder stones) or cholecystitis.  Cholelithiasis is the formation or presence of stones in the gallbladder or bile duct.  Cholelithiasis symptoms are asymptomatic or mild discomfort to extreme pain, often preceded by ingestion of fatty or greasy foods and the pain is usually steady, lasting from 15-30 minutes up to several hours with a spontaneous resolution.  Nausea, vomiting, bloating, flatulence, abdominal tenderness may also be present.   Cholecystitis is the acute or chronic inflammation due to gallstones blocking gallbladder ducts and can cause sudden severe pain, fever, nausea, vomiting, and tenderness in the right upper quadrant which our patient is suffering with.  The doctor will do a patient history, physical exam and some imagining studies such as ultrasound of the abdomen or an oral cholescintigraphy may also be done to diagnose this patient.  Treatment may be to change their diet such as cutting out fatty foods or surgical removal of the gallbladder may be necessary if the condition is severe.

References

Colbert, B. J., Ankney, J., & Lee, K. T. (2013). Anatomy, physiology, & disease: An interactive journey for health professionals (2nd ed.). Upper Saddle River, NJ: Pearson Education.

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