Photo Rounds

Episodic abdominal pain

A 44-year-old woman sought care from her family physician (FP) for frequent episodes of severe pain in the mid and upper right side of her abdomen that usually occurred shortly after eating dinner, and sometimes at night. The patient was obese, but otherwise healthy. The pain was steady, lasting for several hours, and often caused vomiting. On physical examination, she complained of slight tenderness in the right upper quadrant. The FP ordered an ultrasound.

What's your diagnosis?


The ultrasound confirmed the presence of gallstones, with obvious shadowing of the sound waves behind the gallstones. Gallstones are inorganic masses (usually composed of cholesterol) that form in the gallbladder or bile duct. They are formed by concretion (joining together of adjacent parts and hardening) or accretion (growth by addition or adherence of parts normally separated) of normal and/or abnormal bile constituents. Autopsy data suggest 20% of women and 8% of men have gallstones.

In this case, the FP referred the patient to General Surgery for laparoscopic cholecystectomy. She also counseled the patient on the importance of weight loss through eating a low-fat diet and exercising.

Image courtesy of Jeff Russell, MD. Text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Smith M. Gallstones. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:386-392.

To learn more about the Color Atlas of Family Medicine, see:

You can now get the second edition of the Color Atlas of Family Medicine as an app by clicking this link:

Next Article: