## Case Summary

**Patient Details:**  
34 year old Female, Primigravida, 22 weeks POG complaining of right lower chest pain and right upper abdomen pain for 2 months, initially mild and now moderate to severe.

**Symptoms:**  
- No history of breathing difficulty, cough.  
- No relation with food.  
- No aggravating or relieving factor.  
- No history of loss of appetite.

**Investigation Results:**  
- Ultrasound of abdomen: normal.
- Liver Function Tests:  
  - AST: 50  
  - ALT: 58  
  - Rest within normal limits.

**Physical Examination:**  
- Afebrile, Pulse rate: 80 bpm, Blood Pressure: 110/70 mmHg.
- Respiratory System: B/L equal air entry, no added sounds.  
- Tenderness on right lower ribs.

**Current Treatment:**  
Prescribed by Gynecologist: Pantoprazole, antacid, and paracetamol SOS for pain; no relief observed.

### Request for Inputs

Kindly provide your valuable inputs regarding possible causes of this pain in the 2nd trimester of pregnancy and management.