33-year-old woman comes to the office due to a dull, aching pain in the right upper quadrant of the abdomen for several weeks. Her
medical history is unremarkable. She takes no medications except an oral contraceptive, which she has used for the past 12 years.
The patient drinks 1 or 2 glasses of wine on social occasions but does not use tobacco or illicit drugs. Temperature is 36.7 C (98 F),
blood pressure is 120/80 mm Hg, pulse is 78/min, and respirations are 14/min. BM I is 27 kg/m2. Examination shows hepatomegaly
with moderate discomfort on deep palpation in the right upper quadrant. There is no jaundice or ascites. Cardiopulmonary
examination shows no abnormalitie s . Laboratory results are as follows:
Albumin 4.1 g/dl
Total bilirubin 0.9 mg/dl
Alkaline phosphatase 215 U/L
Aspartate aminotransferase (AST,SGOT) 45 U/L
Alanine aminotransferase (ALT, SGPT) 40 U/L
Gamma glutamyl transpeptidase 92 U/L (normal 5-55
U/L)
Abdominal uttrasonogram reveals a sol itary hyperechoic 7-cm lesion in the right lobe of the liver. Which of the foll owing is the most
likely diagnosis in this patient?
- Q A Hepatic adenoma
- 0 B. Hepatocellular carcinoma
- 0 C. Hydatid cyst
- 0 0. Metastatic adenocarcinoma
- 0 E. Regenerating liver nodule
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A 27-year old man presents with a 3-month history of heartburn and epigastric discomfort. His symptoms are exaggerated after meals especially if he eats spicy food. He takes no medications, doesn’t smoke or drink alcohol. He exercises regularly and has an active lifestyle. On physical examination, he has slight epigastric tenderness. His routine lab tests are normal
What is the most appropriate intervention at this time?
- A- Barium swallow
- B- Esophageal manometry
- C- 24-hour pH monitoring
- D- Upper endoscopy
- E- Trial of a proton-pump inhibitor
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