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    Diabetic with RUQ Abdominal Pain - Clinical Patient Case of the Week

    Diabetic with RUQ Abdominal Pain - Clinical Patient Case of the Week

    Try this free Abdominopelvic Disorders Case Q&A courtesy of Med-Challenger.

    This abdominopelvic disorders case comes from our MyEMCert Review and CME course (Abdominopelvic Module), part of Med-Challenger's library of board exam review and CME question banks.

    For more free clinical knowledge review questions, subscribe to the Med-Challenger Medical Education Blog

    Try this case and test your knowledge of abdominopelvic disorders.

    A 67-year-old man with poorly controlled, insulin-dependent diabetes presents with 3 days of fever, nausea, and abdominal pain. He reports the pain as constant and localized in the right upper quadrant.

    Vital signs are: temperature 38.9° C (102 °F), heart rate 110 beats/minute, blood pressure 110/70 mm Hg, respiratory rate 22/minute, and oxygen saturation 95% on room air. His abdomen is soft, but tender to palpation in the right upper quadrant, with a positive Murphy sign.

    Laboratory results are notable for a white blood cell count of 22,000/µL and a blood glucose level of 320 mg/dL.

    Computed tomography of the abdomen is obtained, which is notable for distension of the gallbladder, indicating gallbladder wall thickening, intramural air, and stranding (see Figure).

    Figure 1.

    Abdominopelvic Disorders - right upper quadrant abdominal pain emphysematous cholecystitis

    Question:

    What is a true statement regarding this patient's diagnosis?

    Answer Options:

    This case, like the majority of cases, is due to gallstones.

    It carries a high risk of gallbladder perforation.

    The Murphy sign is always present.

    A history of diabetes is noncontributory.

    See the Answer:

    Want more patient case questions like this?

    This case is a sample from the following Med-Challenger exam prep and continuing medical education package.

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