Right upper abdominal pain and fever in a 46-year-old woman
Emergency DepartmentCarmen Delgado · 46yo female · CC: Right upper abdominal pain, fever, and yellow eyes
History
0/5 key findingsAsk the questions your differential demands — not just the ones the case volunteers. Every diagnosis you intend to list owes you one discriminating question.
CASE SETTING: EMERGENCY DEPARTMENT
Carmen Delgado, a 46-year-old woman with fever, jaundice, right upper quadrant pain, hypotension, and confusion
Vitals
Opening
Carmen Delgado, a 46-year-old restaurant manager, is brought to the Emergency Department by her daughter, Lucia, for 24 hours of unremitting right upper quadrant abdominal pain, shaking chills, yellowing of her eyes, and new confusion over the past 2 hours. Ms. Delgado is febrile to 103.1°F, hypotensive at 86/52 mmHg, tachycardic at 122 bpm, and drowsy but awakens to voice.
Triage note
46-year-old female with 24 hours of constant RUQ pain, fever to 103.1°F with rigors, scleral icterus, and new disorientation. BP 86/52, HR 122, RR 24.
From the daughter
"Yesterday afternoon she got severe pain under her right ribs that never went away. Overnight she started shaking with chills and a 103 fever, this morning her eyes turned yellow, and in the car she didn't know what year it was."
Carmen Delgado · 46yo female
Febrile, drowsy woman with visible scleral icterus lying on the stretcher, accompanied by her daughter Lucia