Sandra, a 41-year-old female, presents to her GP clinic with a three-week history of recurrent upper abdominal pain. The pain is variable in intensity, at worst 4-5/10 severity and experienced mainly in the right upper abdomen, with radiation to the right shoulder and left upper abdomen.

She denies any accompanying nausea, vomiting, diarrhoea or change in bowel habits, but has noticed some ‘swelling’ in the left upper quadrant. There are no associated systemic symptoms and no past medical history of note.

Sandra appears well and comfortable. Her BMI is 25 and vital signs are normal. Her abdomen is soft and non-tender, with no hepatosplenomegaly and a negative Murphy’s sign. Cardiovascular, respiratory and CNS examinations are normal.

Given the diagnostic uncertainty, Sandra is referred for investigations including FBC, EUC, LFTs, serum lipase and MSU. These are all normal.