The patient is a 73-year-old woman with type 2 diabetes and hypertension who presented to a local community hospital with abdominal pain, nausea, vomiting, nonbloody diarrhea, and weight loss over five weeks. Exam She was afebrile, blood pressure was 148/77, and she was tachycardic to 109 beats per minute, Exam was notable for mild diffuse tenderness in her abdomen and an enlarged liver on palpation. Labs WBC of 12,600 cells/μL Bicarbonate of 11 mEq/L BUN of 29 mg/dL Creatinine of 1.2 mg/dL with an anion gap of 30 Troponins were undetectable and lactate was elevated at 4.9 mmol/L. Mild transaminitis was present with ALT of 32 U/L and AST of 50 U/L; alkaline phosphatase was elevated at 231 U/L.
However, normal values included albumin of 4.3 g/dL and INR of 1.0. Radiologic exam A chest X-ray was unrevealing. An abdominal CT showed a well-defined lesion in the superior right hepatic lobe…
