Question of the Week

For March 28, 2023

A 72-year-old woman with a history of hypertension and well-controlled type 2 diabetes presents to the emergency department with a one-week history of upper abdominal discomfort. The discomfort, which she describes as a gnawing sensation, initially occurred once or twice daily and lasted 5 to 10 minutes, but now it occurs more frequently and lasts longer. Her latest episode, which occurred while she was walking down a hallway, was accompanied by nausea, fatigue, and diaphoresis.

Her medications include metformin, aspirin, and lisinopril.

Her blood pressure is 154/89 mm Hg, and her heart rate is 98 beats per minute. An abdominal examination is unremarkable, although she reports mild discomfort that began while she was registering for the visit. Liver function test results and pancreatic enzyme levels are within normal limits.

CT of the abdomen and pelvis with intravenous contrast is unremarkable.

Which one of the following evaluations is most appropriate for this patient?

Barium swallow
Magnetic resonance cholangiopancreatography
D-dimer testing

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