Can you make the diagnosis?

A 32-year-old woman has just arrived home after a family picnic, where she enjoyed friend chicken, potato salad, and corn on the cob.

She has just sat down on the couch to watch her favorite show when she has onset of stomach pain.  Thinking it is heartburn, she goes to the bathroom to take a few antacid tablets.

Soon after however the pain intensifies.  It now seems worse on the right, under her ribs.  The pain is so severe it causes her to vomit.

She decides to go to the Emergency Department.  Once there, the nurse checks her vital signs which are normal.  The patient tells the nurse her pain is better now, and asks if she should just go home.   The nurse talks her into staying.

The doctor then sees her, and orders blood work, which is normal.  An ultrasound is then ordered.   What does it show?



  1.  Nothing, she is just having heartburn.
  2. Appendicitis
  3. An ulcer
  4. Gallstones



If you guessed gallstones, you are right!  Gallstones are stones that form in the gallbladder, which is below our liver on the right side.  They cause severe pain, and can cause vomiting.  Women are at higher risk for gallstones, and women who have had multiple children are at even higher risk.   That is because increased estrogen leads to gallstone production.  Men can also get gallstones however.  Obese individuals are also at higher risk.  Patients with other medical conditions such as diabetes and high triglycerides are also at risk.

Appendicitis causes pain that is usually on the right lower portion of the abdomen.  Ulcer pain usually comes on gradually, is in the upper middle part of the stomach, and is can not usually be seen on an ultrasound.

Gallstone pain often comes on after eating a fatty meal, such as friend chicken.  Gallstones typically need to be treated surgically.

Gallstones in the gallbladder:


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