A 68-Year-Old Woman With Weight Loss and Abdominal Pain

Nafisa Kuwajerwala, MD; Angad Pordal, MD

Disclosures

October 19, 2018

Physical Examination and Workup

Upon physical examination, the patient's vitals are normal. Her lungs are clear to auscultation bilaterally, and she has a regular heart rate and rhythm. Her abdomen is soft, mildly distended, and mildly tender to palpation diffusely, with increased tenderness in the right, upper quadrant.

No guarding, rebound, or rigidity is observed. She has a negative Murphy's sign. She is found to have a white blood cell count of 9.4 × 109/L and a hemoglobin level of 13.5 g/dL. Her total bilirubin level is 0.5 mg/dL. Her alkaline phosphatase level is 140 IU/L. Her alanine aminotransferase level is 98 U/L, and her aspartate aminotransferase level is 73 U/L. She states that she previously underwent a CT scan of her abdomen at an outside institution.

MRI of the abdomen reveals the findings below.

Figure 1.

Figure 2.

Figure 3.

Figure 4.

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