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RUQ pain

22 yr old male with c/o RUQ pain for 48 hours accompanied by nausea and anorexia the past couple of days. The pain started 8 hours after a drinking binge 2 days ago (approx 1/2 liter of vodka shots). Pain has been worsening over the past 48 hours from a 2/10 to 5/10. Vomited twice the initial morning after binge, no vomiting since. He had a similar episode X1 some months ago after drinking too much but it was less severe and went away fairly quickly. Admits to drinking binge X2 yrs mostly on weekends. Denies stress but does have a history of anxiety disorder and panic attacks since high school. He is visibly anxious with sweat beads on his forehead and nose. He tried a course of Ativan a year ago but finds that marijuana helps or he just rides it out. Denies H/A, visual changes, has had blackouts from drinking, balance issues routinely, chest tightness and SOB with panic attacks only. Denies DOE, epigastric pain or pain in RLQ or LLQ.

Vital Signs: T 97.6; BP 150/80; HR 92; RR 18; O2 SAT 99% ra; Ht 72 in; WT 180 lbs.

Patient had to leave in a hurry for midterms but returned in 2 days. See below:

Labs: WBC 13.3; HGB 15.1; Plts 125,000; Amylase 250u/L; Lipase 200u/L; AST 180u/L, SST/ALT ratio 3.1; T-Bili 2.1; D-Bili 0.3 mg/dl; Hep panel A, B, C all negative; GGT elevated; ABD films with non-descriptive air patterns; no ileus or obstructive patterns.