56 year old Vietnamese woman with recurrent right upper quadrant
pain and abnormal liver tests
History of the Present Illness:
The history is from the patient and her daughter without any
medical records. Ten years ago, in Vietnam, she had right upper quadrant abdominal
pain radiating to her back, nausea,vomiting, and fever. She was diagnosed
and treated for liver flukes (?Clonorchis sinensis) with praziquantel.
She immigrated to the United States nine years ago. For seven years she experienced
intermittent, mild, right upper quadrant discomfort. Two years ago,
she had a severe attack of right upper quadrant pain, fever, nausea, and vomiting
that prompted her hospitalization at a local hospital. She was treated
with intravenous antibiotics and recovered; no further studies were done.
For the last year and a half, the patient has had intermittent right upper
quadrant abdominal pain associated with meals that has increased in frequency
and severity over the past four months. She had been placed on proton-pump
inhibitors without relief. The pain now occurs 10 minutes after meals,
radiates to her back, lasts several hours, and is slightly reduced by lying
supine. She also has anorexia, fevers, chills and a 5 lb. weight loss over
the past month. There is no history of hepatitis, jaundice, substance
abuse, or herbal medication use. She has been using acetaminophen for
her pain and denies any NSAIDs use.
Previous Medical Diagnoses, Hospitalizations, and Operations:
As stated above.
Current Medications:
Pantoprazole, Cefepime and Flagyl
Personal and Social History:
No alcohol or tobacco use; no substance abuse; no travel;
stable family and finances
