Right Upper Quadrant Ultrasound

Buckeyes... the candy kind.  By Steven Depolo [CC BY 2.0 (http://creativecommons.org/licenses/by/2.0)], via Wikimedia Commons

You are talking to your new patient, John.  He's a pleasant 30 year old man who, by your estimation appears to be a victim of HGS... Holiday Gluttony Syndrome.  John presented to you in the ED with abdominal pain, nausea, and vomiting.  He goes on to tell you all this started after he chowed his way through a few too many Buckeyes.  You see every Christmas, his mom sends him a far too large tin of Buckeye candies, which John had eagerly eaten and eaten and eaten, until the belly pain hit.

 He tells you he thought it was just a typical belly ache and that it would pass, but for the past 3 hours he's had constant right upper quadrant and epigastric abdominal pain which is burning and aching in quality.  He's had a couple episodes of non-bloody, non-bilious emesis to go along with it.  He sorta remembers some similar pain in the past after eating but can't be too sure about it.  On exam you find him to have some pretty significant epigastric and right upper quadrant pain.  You're mind spins through the differential as you look over the labs sent in triage.  Normal CBC, normal LFTs, normal lipase, normal renal panel.  You know that despite the normal labs, something still isn't right about his exam.  Still worried about symptomatic cholelithiasis or cholecystitis, you wheel the ultrasound into the room.