b’John Smith is a 65-year-old retiree who is admitted to your unit from the emergency department (Ed). On arrival, you note that he is trembling and nearly doubled over with severe abdominal pain. John’

b’nJohn Smith xc2xa0is a 65-year-old retiree who is admitted to your unit from the emergency department (Ed). On arrival, you note that he is trembling and nearly doubled over with severe abdominal pain. John indicates that he has severe pain in the right upper quadrant (RUQ) of his abdomen that radiates through to his mid back as a deep, sharp, boring pain. He is more comfortable walking or sitting bent forward rather than lying flat in bed. He admits to having had several similar bouts of abdominal pain in the last month, but “none as bad as this.” He feels nauseated but has not vomited, although he did vomit a week ago with a similar episode. John experienced an acute onset of pain after eating fried fish and chips at a fast-food restaurant earlier today. He is not happy to be in the hospital and is grumpy that his daughter insisted on taking him to the emergency department for evaluation.xc2xa0After orienting him to the room, you perform your physical assessment. The findings are as follows: He is awake, alert, and oriented xc3x97 3, and he moves all extremities well. He is restless, constantly shifting his position, and complains of fatigue. Breath sounds are clear to auscultation. Heart sounds are clear and crisp, with no murmur or rub noted and with a regular rate and rhythm. Abdomen is flat, slightly rigid, and very tender to palpation throughout, especially in the RUQ; bowel sounds are present. He reports having light-colored stools for 1xc2xa0week. The patient voids dark amber urine but denies dysuria. skin and sclera are jaundiced.xc2xa0Admission vital signs are blood pressure 164/100, pulse of 132 beats/min, respiration 26 breaths/min, temperature of 100xc2xb0 F (37.8xc2xb0 C), spo2 96% on 2 L of oxygen by nasal cannula.Preoperative Laboratory Test Resultsxc2xa0xc2xb7xc2xa0xc2xa0xc2xa0xc2xa0xc2xa0xc2xa0xc2xa0WBC 11,900/mm3xc2xa0xc2xb7xc2xa0xc2xa0xc2xa0xc2xa0xc2xa0xc2xa0xc2xa0Hgb 14.3xe2x80x89g/dLxc2xa0xc2xb7xc2xa0xc2xa0xc2xa0xc2xa0xc2xa0xc2xa0xc2xa0Hct 43%xc2xa0xc2xb7xc2xa0xc2xa0xc2xa0xc2xa0xc2xa0xc2xa0xc2xa0Platelets 250,000/mm3xc2xa0xc2xb7xc2xa0xc2xa0xc2xa0xc2xa0xc2xa0xc2xa0xc2xa0ALT 200xe2x80x89units/Lxc2xa0xc2xb7xc2xa0xc2xa0xc2xa0xc2xa0xc2xa0xc2xa0xc2xa0AST 260xe2x80x89units/Lxc2xa0xc2xb7xc2xa0xc2xa0xc2xa0xc2xa0xc2xa0xc2xa0xc2xa0ALP 450xe2x80x89units/Lxc2xa0xc2xb7xc2xa0xc2xa0xc2xa0xc2xa0xc2xa0xc2xa0xc2xa0Totalxe2x80x89bilirubin 4.8xe2x80x89mg/dLxc2xa0xc2xb7xc2xa0xc2xa0xc2xa0xc2xa0xc2xa0xc2xa0xc2xa0PT/INR 11.5xe2x80x89sec/1.0xc2xa0xc2xb7xc2xa0xc2xa0xc2xa0xc2xa0xc2xa0xc2xa0xc2xa0Amylase 50xe2x80x89units/Lxc2xa0xc2xb7xc2xa0xc2xa0xc2xa0xc2xa0xc2xa0xc2xa0xc2xa0Lipase 23xe2x80x89units/Lxc2xa0xc2xb7xc2xa0xc2xa0xc2xa0xc2xa0xc2xa0xc2xa0xc2xa0Urinalysis Negative1.xc2xa0xc2xa0xc2xa0xc2xa0xc2xa0What organs are located in the RUQ of the abdomen?xc2xa0(Start thinking about what organ is involved based on his chief complaint) ‘

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