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Endocrine Case Report: Cirrhotic with Epigastric Pain

The latest case report from Brady Pregerson, MD, features a man in his 60s with a history of diabetes and cirrhosis presenting with 2 weeks of right upper quadrant pain with constipation and 2 days of vomiting. Can you determine the correct diagnosis?

History of Present Illness:

A man in his 60’s with a history of diabetes and cirrhosis presents to the hospital with 2 weeks of RUQ pain radiating to the back with constipation and now 2 days of vomiting. He was triaged as having RLQ pain, not RUQ pain. He denies any fever, bleeding, melena or other complaints.

Vital Signs & Physical Exam:

Vital signs are normal except for a pulse of 101. Physical exam is otherwise normal except for epigastric but not RLQ tenderness

Initial Diagnostic Testing:

CBC: normal except for 79% PMNs

Chem 7: normal except for sodium of 128. LFT’s mildly elevated

Imaging: A CT scan is done

What is the diagnosis?