Upper quadrant pain
Author and Disclosure Information [Show]

W. Scott Butsch, MD, MSc, Director of Obesity Medicine, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.

Dr. Butsch has disclosed the following relevant financial relationships:
Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: Novo Nordisk, Inc.

Courtney Whittle, MD, MSW, Diplomate of ABOM, Pediatric Lead, Obesity Champion, TSPMG, Weight A Minute Clinic, Atlanta, Georgia.

Courtney Whittle, MD, MSW, Diplomate of ABOM, has disclosed no relevant financial relationships.

Question 1 of 3

A 45-year-old White male presents to his primary care physician complaining of postprandial intermittent right upper quadrant pain at least two days per week. He denies any nausea, vomiting, or diarrhea. The patient is 6 ft 0 in, weighed 250 lb, BMI 33.9, and began a medically supervised lifestyle program that consisted of a physical activity routine of more than 200 minutes per week and a high protein diet, using two meal replacements (for breakfast and lunch) per day. He lost 55 lbs in 9 months and is now 195 lb, BMI 26.4

The physical exam shows a positive Murphy sign and voluntary guarding but no peritoneal signs. Laboratory results (CBC with differential, liver function panel, amylase, and lipase) are unremarkable.

What is the next step in the diagnostic process for this patient?


Abdominal radiography



This quiz is not accredited for CME.

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