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

Andrea Eberly, MD, MS, FAAEMClinical Pearls, Emergency Medicine, Family Medicine, Guideline Knowledge Check, Internal Medicine, Nurse Practitioner, Nursing RN/PN, Pediatric Emergency Medicine, Pediatric Medicine, Personal Education, Physician Assistant, Urgent Care

Diabetic with Abdominal Pain, Abdominopelvic Disorders - Clinical Patient Case of the Week - emphysematous cholecystitis

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.

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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:

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