Review Question - QID 214702

A 36-year-old man presents to the emergency department with complaints of right upper quadrant (RUQ) and epigastric pain. He endorses a 6/10, sharp, intermittent pain that is associated with some nausea over the past 3 hours. The pain began after he ate lunch, and he reports similar episodes in the past that resolved on their own. He took some over the counter pain medication without any relief. He denies any fever, chills, headache, chest pain, shortness of breath, or urinary symptoms. The patient is currently on methotrexate and folic acid for the treatment of Crohn disease. He reports drinking 6-8 beers a night and admits to “drinking a little more than usual” the night before. He denies any smoking or drug use. A physical examination reveals tenderness at the RUQ and epigastric areas with a positive Murphy sign. Laboratory studies are shown below:

Serum:
Na+: 136 mEq/L
Cl-: 96 mEq/L
K+: 4.1 mEq/L
HCO3-: 23 mEq/L
Urea nitrogen: 10 mg/dL
Glucose: 115 mg/dL
Creatinine: 1.1 mg/dL
Alkaline phosphatase (ALP): 145 U/L
Aspartate aminotransferase (AST, GOT): 65 U/L
Alanine aminotransferase (ALT, GPT):43 U/L
Bilirubin, total: 2.5 mg/dL
Bilirubin, direct: 2.1 mg/dL
Lipase: 149 U/L

Urine:
Epithelial cells: 1/hpf
Glucose: Negative
WBC: 0/hpf
RBC: 0/hpf
Bacterial: None

What is the most likely explanation for this patient’s symptoms?