Gastro Case Challenge: A Woman Who Abstains from Alcohol Has Worsening Abdominal Pain

Vanya Grover, DO; Solmaz Amirnazmi, MD; Robert Graham, MD, MPH


May 05, 2022

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case you would like to suggest for a future Case Challenge, please contact us.


A 61-year-old woman with a medical history of insulin-dependent diabetes mellitus for 7 years, hypertension, hyperlipidemia, and one previous episode of idiopathic pancreatitis presents with worsening abdominal pain that has lasted for the past month. The pain is intermittent and localized to the epigastric region. It is nonradiating and not associated with food intake.

No nausea, vomiting, diarrhea, constipation, vaginal discharge or bleeding, fever, coughing, or urinary symptoms are reported. She denies having any chest pain or shortness of breath. She is not a smoker. She states that has abstained from any alcohol use for as long as she can remember. She cannot identify any exacerbating or relieving factors for her pain.

Her previous medical history includes a total abdominal hysterectomy with bilateral salpingo-oophorectomy performed 30 years ago. The family history is significant for pancreatic cancer in her mother, the details of which are unknown to the patient. Her medications include insulin, lisinopril, and simvastatin. Her diabetes control has been poor, and a recent hemoglobin A1c value was 10%.


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