system
Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response.
user
A 48-year-old woman presents to the emergency department because of increasingly severe right upper abdominal pain, fever, and non-bloody vomiting for the last 5 hours. The pain is dull, intermittent, and radiates to her right shoulder. During the past 3 months, she has had recurring abdominal discomfort after meals. The patient underwent an appendectomy more than 30 years ago. She has hypertension, diabetes mellitus type 2, and chronic back pain. She takes bisoprolol, metformin, and ibuprofen daily. She is 171 cm (5 ft 6 in) tall and weighs 99 kg (218 lb). Her BMI is 35.2 kg/m2. She appears uncomfortable and is clutching her abdomen. Her temperature is 38.5°C (101.3°F), pulse is 108/min, and blood pressure is 150/82 mm Hg. Abdominal examination shows right upper quadrant abdominal tenderness and guarding. Upon deep palpation of the right upper quadrant, the patient pauses during inspiration. Laboratory studies show the following:
Blood
Hemoglobin 13.1 g/dL
Leukocyte count 10,900/mm3
Platelet count 236,000/mm3
Mean corpuscular volume 89/µm3
Serum
Urea nitrogen 28 mg/dL
Glucose 89 mg/dL
Creatinine 0.7 mg/dL
Bilirubin  
Total 1.6 mg/dL
Direct 1.1 mg/dL
Alkaline phosphatase 79 U/L
Alanine aminotransferase (ALT, GPT) 28 U/L
Aspartate aminotransferase (AST, GOT) 32 U/L
An X-ray of the abdomen shows no abnormalities. Further evaluation of the patient is most likely to reveal which of the following?
assistant
History of multiple past pregnancies