A 32-Year-Old Woman Is Brought to the Emergency Department an Hour

question 517

Multiple Choice

A 32-year-old woman is brought to the emergency department an hour after developing acute-onset, right upper quadrant abdominal pain followed by syncope.  The patient works at her family farm and felt well prior to the onset of these symptoms.  She has no chronic medical conditions.  She is sexually active and uses combined estrogen-progestin oral contraceptives.  She does not use tobacco, alcohol, or illicit drugs.  Temperature is 38.1 C (100.6 F) , blood pressure is 80/50 mm Hg, pulse is 120/min, and respirations are 20/min.  Oxygen saturation is 95% on room air.  The patient appears anxious and pale.  Examination shows abdominal distention, diffuse abdominal tenderness, and tender hepatomegaly.  Bowel sounds are decreased.  Extremities are cold, and capillary refill is delayed.  Laboratory results are as follows: Abdominal ultrasound of the right upper quadrant shows a solid liver mass and free fluid in the abdomen.  Which of the following is the most likely diagnosis?

• A)Focal nodular hyperplasia
• B)Hepatic abscess
• C)Hepatic adenoma
• D)Hepatic hemangioma
• E)Hepatocellular carcinoma
• F)Hydatid cyst

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