Question

A 45-year-old obese woman presents to the emergency room with steady, severe, aching pain in the upper right quadrant that radiates to the right scapula. The onset was acute and occurred 30 minutes after lunch. She also reports nausea with vomiting. On physical exam, it is noted that she stops breathing on deep palpation of the right quadrant. Laboratory studies show an absolute neutrophillic leukocytosis with a left shift. What is the diagnosis?

Answer 1

The clinical presentation of steady, severe, aching pain in the upper right quadrant that radiates to the right scapula, along with nausea and vomiting, is highly suggestive of cholecystitis. The presence of absolute neutrophilic leukocytosis with a left shift further supports this diagnosis.

Step-by-step explanation:

The diagnosis for this patient is cholecystitis, which refers to inflammation of the gallbladder. The clinical presentation of steady, severe, aching pain in the upper right quadrant that radiates to the right scapula, along with nausea and vomiting, is highly suggestive of cholecystitis. The fact that the patient stops breathing on deep palpation of the right quadrant further supports this diagnosis.

Absolute neutrophilic leukocytosis with a left shift, as indicated by the laboratory studies, is also a common finding in cholecystitis. This condition is often associated with obesity, and the patient's demographics align with this risk factor.

It is important for the patient to receive further evaluation and appropriate treatment for cholecystitis, which may include antibiotics, pain management, and potential surgical intervention.