A Sweet Source of Abdominal Pain

A CLINICAL IMPLICATIONS OF BASIC RESEARCH article by Shari Rogal from Brigham and Women's Hospital, Boston.
A 25-year-old woman presented to her primary care physician for evaluation of abdominal pain. Her discomfort had begun 6 months earlier and was localized to the right upper quadrant of the abdomen. She described a constant pressure unrelated to food intake that was associated with intermittent nausea and vomiting.
The patient's medical history was notable for type 1 diabetes mellitus, which had been diagnosed in childhood and was complicated by several episodes of diabetic ketoacidosis, hypothyroidism, psoriasis, and a seizure disorder, as well as juvenile rheumatoid arthritis, which was diagnosed when she was 18 months of age, after the development of arthritis in her right ankle and uveitis in both eyes.
On physical examination, the patient was a thin, anicteric woman who was not in acute distress. Laboratory studies showed that the elevated hepatic enzyme levels; the patient also had a high mean corpuscular volume, an elevated blood urea nitrogen to creatinine, and hyperglycemia. Doppler ultrasonography of the abdomen showed hepatomegaly, with no fatty infiltration or vascular abnormalities and normal echogenicity. The kidneys were normal with respect to echogenicity but were enlarged, both measuring 13.9 cm in length.
An interactive medical case related to this article is available at NEJM.org. [Original Article]

Notes

• ketoacidosis: アクセントのない音節のtは無気音になり、タ行かダ行か判別が難しくなります。
• psoriasis: 形容詞形のpsoriaticとともにアクセントの位置に注意。
• uveitis: 内科ではあまり使わない用語にも注意が必要です。
• anicteric: 字面では了解可能だが、アクセントの位置に注意。