56M no PMH p/w RUQ pain

Jeremy Price, MSIVAlbert Einstein College of MedicineJuly 19, 201356M no PMH p/w RUQ painCaseRUQ pain x3 days, began gradually now 10/10 and constant, sharp, radiating around to the back, accompanied by nausea, vomiting x1. Denies fever, dysuria, frequency, hematuria, change in bowel habits.PMH: nonePSHx: noneMeds: noneAllergies: NKDASH: denies toxic habitsFH: non-contributoryPhysical ExaminationVital SignsT 97.2FBP 130/74P 56R 1897% on RAGeneral: AAOx3, thin middle-aged Hispanic male lying on stretcher in obvious discomfortHEENT: mmm, no scleral icterusNeck: supple, no LAD, no JVDPhysical Examination contdCV: S1, S2, RRR, no m/r/gResp: CTAB, good air entry, no wheezesAbd: soft, nondistended, mildly tender to palpation in RUQ, negative Murphys sign, normoactive BS, no organomegalyBack: severe R CVA tenderness

Differential DiagnosisRUQ pain:CholelithiasisAcute cholecystitisCholangitisAcute hepatitisPerforated duodenal ulcerRLL pneumonia

R Flank pain:NephrolithiasisUrolithiasisRetroperitoneal hematomaRuptured renal cystUreteral stricturePyelonephritisPerinephric abscessRuptured AAA

LabsCBC: 8.1>12.6/37.7