A 32-year-old G1P0 woman at 7 4/7 weeks’ gestation (intrauterine pregnancy confirmed by ultrasound) with a history of hypertension and anxiety presented to the emergency department reporting right upper quadrant and right flank pain. The patient did not report taking any medications. Her symptoms had begun about 6 hours prior to presentation. She did not report fever, chills, nausea, vomiting, anorexia, or urinary or bowels symptoms. She was afebrile, and her initial blood pressure was 174/84 mm Hg, but within an hour of presentation had decreased to 137/82 mm Hg.
On exam she was in moderate-to-severe discomfort. She was tender to palpation in the right flank as well as the right upper quadrant and had a positive Murphy sign. Her white blood cell (WBC) count was 18,800/μL, hemoglobin and hematocrit were normal, liver function tests were within normal limits, and sodium was 133 mmol/L; otherwise, electrolytes were normal. The urinalysis showed a specific gravity of 1.022 with 3 red blood cells per high powered field, but was otherwise normal. A right upper quadrant ultrasound showed a normal gallbladder without cholelithiasis. Subsequently, a magnetic resonance imaging (MRI) of the abdomen was obtained (Figure 1).
- What is your diagnosis?
- How would you treat this patient?
[Click through to the next page to see the answer.]