Hello, med students. My name is Zach Olson, and thank you for downloading this week's

episode of the EM Clerkship Podcast. We are in our summer of abdominal angst. We are going through

this big list of all of the abdominal pain can't miss diagnoses. We've covered our first two of the quadranties last week, penicitis and diverticulitis.

And let's round out that subcategory of life threats and important diagnoses this week.

And we're going to be talking about billiary stuff in the right upper quadrant and then the pancreatitis, which is kind of, you know, it's like

epigastrum, left upper quadrant, a little arbitrary, but that's what we're talking about

this week, biliary pancreatitis. Let's go. Hello, Dr. Olson. I have a 48-year-old male

with a past medical history of diabetes, obesity, and appendectomy.

No other abdominal surgical history who presents with abdominal pain.

He describes it as a severe, sudden onset, right upper quadrant abdominal pain that started a few hours ago and radiates around to his back.

He has not had any fevers, vomiting, urinary symptoms, or any other complaints.

Vital signs are all within normal limits.

On exam, he has focal tenderness over the right upper quadrant, but otherwise a benign abdomen.

He has a negative Murphy's sign.

He has no CVA tenderness.

It sounds like simple bilari colic, to be honest, but we need to rule out colitis, pancreatitis, and acute coronary

syndrome. For my testing plan, I would like to get a CBC, a BMP, liver function tests,

lipase, EKG, troponin, and a right upper quadrant ultrasound. And for my treatment

plan, I would like to get them four milligrams of IV Zophran, four milligrams of IV morphine,

a liter of fluids, normal saline, and let's keep them in PO for now. All right. So this week,

the upper quadranties, the biliary diagnoses. Let's start with

billiary. And so I think that the most important thing here, because I've worked with

...