華山論劍-專業案例挑戰/Case 2015-006

Date: 30 Sep. posted by 方律涵/王文倫/陳志城/張吉仰醫師學術天地

History

This 62-year-old man presented to our hospital with history of intermittent epigastric dull pain for two months. Mild nausea sensation and hunger pain were accompanied occasionally. There were neither radiation pain to the back, nor febrile in these days. He is a heavy drinker, and did not recall any history of abdominal trauma or surgery before. The patient had ever visited local hospital, where reflux esophagitis was diagnosed by Upper GI endoscopy. Medical treatments with PPI were given, but the symptoms persisted. He was then referred to our hospital. The physical examination disclosed mild tenderness over RUQ, with equivocal Murphy’s sign. The white cell counts were 4930/μl, and his liver function tests (ALT, T-bil, ALP) were all within normal limit. Abdominal ultrasound was performed (Figure 1).

Figure 1

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