Right upper quadrant pain and raised alkaline phosphatase is not always a hepatobiliary problem
نویسندگان
چکیده
Right upper quadrant pain is a common presenting complaint to the general and hepatobiliary surgical team. Differential diagnoses include gallstones, cholecystitis, liver and pancreatic pathology. A 64-year-old man presented to our general surgical unit with right upper quadrant pain and deranged liver function tests. He underwent ultrasonography several times as well as magnetic resonance cholangiopancreatography (MRCP) in pursuit of hepatobiliary pathology. However, it was the identification of an empyema on MRCP that led to computed tomography of the thorax and the eventual discovery of the cause of the pain: a paraspinal abscess causing T10/T11 discitis. Right upper quadrant pain and deranged liver function tests justify hepatobiliary investigation. Nevertheless, after several negative tests, the differential diagnoses should be broadened and referred pain considered.
منابع مشابه
Distribution of alkaline phosphatase in serum protein fractions.
A technique for measuring the alkaline phosphatase activity of serum protein fractions separated by electrophoresis on cellulose acetate strips is described. Alkaline phosphatase activity in alpha 2, alpha 1, and beta globulins and in albumin is present in varying proportions in normal and pathological sera. In normal sera peak activity is in the alpha 2 globulins and beta globulins have a litt...
متن کاملGallbladder Agenesis with Refractory Choledocholithiasis
Congenital agenesis of the gallbladder is a rare anomaly which is usually asymptomatic and found incidentally. In some cases, however, patients are symptomatic. Common symptoms include right upper quadrant abdominal pain, nausea, and vomiting. Jaundice is present in some symptomatic cases and is due to associated choledocholithiasis (Fiaschetti et al. 2009). In this case, a 63-year-old female p...
متن کاملGallbladder infarction and liver abscess formation following right hepatic artery chemoembolization for metastatic neuroendocrine tumor
A 42-year-old Iraqi woman with hypertension, peptic ulcer disease, and metastatic carcinoid disease presented to the emergency department (ED) with right upper quadrant pain and subjective fevers following chemoembolization for a neuroendocrine tumor of the liver diagnosed by biopsy in Iraq in 2000. The patient had undergone chemoembolization with polyvinyl alcohol particles 3 weeks prior to ar...
متن کاملPyogenic liver abscess: clinical profile, microbiological characteristics, and management in a Hong Kong hospital.
BACKGROUND AND PURPOSE Pyogenic liver abscess (PLA) is a major hepatobiliary infection with a significant mortality rate of 10% to 25%. Over the past 2 decades, there have been significant developments in the management of this disease. This study describes the demographic, clinical, and microbiological features, management, and poor prognostic factors of PLA in Hong Kong. METHODS All patient...
متن کاملAmebic Liver Abscess
A 45 year-old woman presented with a 6-week history of constant right upper quadrant abdominal pain, 20-lb weight loss, and worsening fevers. The patient had immigrated to the United States from Mexico 7 years earlier. She was febrile, experienced pain with light palpation of the right upper quadrant, and had normal serum transaminases, normal alkaline phosphatase, and mildly elevated total bil...
متن کامل