Yes, this is Yes, this is Emk's best case ever mini podcast series, and I'm your host, Dr. Anton Hellman.

On a previous Best Case Ever with Dr. Brian Steinhart, we talked about thinking outside the abdominal box.

In this best case ever, for Dr. Carr's

best case ever series, we're going to dig a bit deeper into thinking outside the abdominal box.

Dr. Carr, let it rip. So this was a fascinating case. Not one of the typical ways that you see

patients present. So I saw this 70-year-old guy.

This 70-year-old guy had no past medical history and no medications. Now, those aren't always

created equal. There are a subset of people who never go to see doctors, and either they're

super healthy or not interested. He was the latter. So this is a

gentleman whose family forced him to go to the emerge and you always have to be worried about these

sort of patients who don't want to fill up your time for no good reasons. This is a 70 year old guy

with a three-day history. He's had severe abdop pain in his right upper quadrant with occasional diarrhea.

He has no blood in his stool, but is vomiting, and has abdopane that's five out of ten.

You look at his vitals, 37.4, 168 over 93, 78, 98%, and arrests of 20. You go see this gentleman and he really complains of severe right

upper quadrant pain and vomiting. He tells you that his bowel movements are normal. He really

only had a few loose stools, no bloody or black stools. He hasn't had travel and he certainly

hasn't had any chest pain or shortness of breath.

It only hurts in his right upper quadrant.

You ask him about if he's ever had gallstones, if he's ever had an ultrasound, and he's very

quick to point out to you that he doesn't see doctors, and he hasn't had blood work or an

ultrasound or anything to that matter.

You examine him.

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