Case presentation A 79-year-old retired pharmaceutical representative presented in the OPD with a 3-month history of intermittent right upper quadrant abdominal discomfort, loss of appetite, and general lethargy. His abdominal pain is in the right upper quadrant. It is colicky in acute recurrent episodes lasting 60 secs, usually for a few days. He is then pain-free for a few weeks. He is intolerant to fatty foods and describes excessive flatulence. There is no change in his bowel habits and no urinary symptoms.
Medical history He has had primary immune thrombocytopenia, diverticular disease, and duodenal ulcer. He also has essential hypertension and type 2 diabetes mellitus. Medication history His medications are ranitidine 150 mg bd, omeprazole 20 mg od, amlodipine 10 mg od, and mebeverine 135 mg tds. Social history He is an ex-smoker of 30 years with a 20-pack-year history. He drinks…
