Alcohol Abuse and Unusual Abdominal Pain in a 49-Year-Old

Gregory Taylor, DO; Michael Semple, DO; Matthew Warpinski, DO


October 02, 2020

Physical Examination and Workup

Upon arrival to the ED, the patient has a temperature of 97.9°F (36.6°C), a heart rate of 91 beats/min, a respiratory rate of 23 breaths/min, blood pressure of 113/85 mm Hg, and 98% saturation on room air.

Upon physical examination, he appears uncomfortable and is lying on his right side; he is slightly diaphoretic, with dry oral mucosa. Abdominal examination reveals a soft abdomen with apparent tenderness to palpation in the epigastric and periumbilical region, with minimal left upper-quadrant pain. His abdominal pain appears out of proportion to the physical examination findings.

His laboratory values are as follows:

  • White blood cell count: 13,000 cells/µL (reference range, 4,000-11,000 cells/µL)

  • Hemoglobin level: 14.1 g/dL (reference range, 13.5-17.5 g/dL)

  • Hematocrit: 39% (reference range, 41%-50%)

  • Platelet count: 506,000 cells/µL (reference range, 150,000-400,000 cells/µL)

  • Aspartate aminotransferase level: 126 U/L (reference range, 6-34 IU/L)

  • Alanine aminotransferase level: 81 U/L (reference range, 7-55 U/L)

  • Amylase level: 125 U/L (reference range, 30-110 U/L)

  • Lipase level: 419 U/L (reference range, 0-160 U/L)

  • Gamma glutamyltransferase level: 58 U/L (reference range, 8-38 U/L)

  • Lactate dehydrogenase level: 175 U/L (reference range, 140-280 U/L)

  • Lactic acid level: 0.7 mmol/L (reference range, 0.5-2.2 mmol/L)

  • Glucose level: 102 mg/dL (reference range, <100 mg/dL)

Rectal examination findings are negative for occult blood. All other laboratory values are unremarkable, including alcohol level. Subsequent CT of the abdomen/pelvis with intravenous contrast was performed (Figures 1-3).

Figure 1.

Figure 2.

Figure 3.


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