50-Year-Old Male with Chronic Alcohol Use Disorder Presenting with Abdominal Pain and Stool Changes

Case at a Glance

A 50-year-old male with a 15-year history of alcohol use disorder presents with right-sided back pain, pale stools with yellow liquid, and morning nausea after 4 days of sobriety.

Patient's Story

The patient reports a 15-year history of chronic alcohol consumption, with escalation over the past 4-5 years. Primary beverage consumed was red wine. He initiated sobriety 4 days prior to presentation due to concerning symptoms. Over recent months, he developed dull pain under the right scapula, bilateral flank pain suggestive of renal involvement, and chronic diarrhea that was dark-colored during active drinking. Following cessation of alcohol, bowel movements changed to pale-colored stools accompanied by pale yellow liquid. The patient denies jaundice, weight loss, or appetite changes but reports morning nausea persisting for several months.

Initial Assessment

Patient appears alert and oriented, currently 4 days into alcohol withdrawal. Vital signs stable. Physical examination reveals tenderness in the right upper quadrant and possible hepatomegaly. No obvious jaundice noted on initial inspection. Patient reports adequate oral intake and denies fever or chills.

The Diagnostic Journey

Initial differential diagnosis includes alcoholic liver disease, gallbladder pathology (cholecystitis, choledocholithiasis), alcohol withdrawal syndrome, and possible biliary obstruction. Laboratory workup indicated to assess liver function, bilirubin levels, and pancreatic enzymes. Imaging studies including abdominal ultrasound or CT scan recommended to evaluate hepatobiliary system and rule out gallstones or ductal obstruction.

Final Diagnosis

Based on clinical presentation and diagnostic imaging, the patient was diagnosed with choledocholithiasis (bile duct stones) with secondary biliary obstruction. Concurrent findings of early alcoholic liver disease were also noted.

Treatment Plan

Immediate management focused on alcohol withdrawal monitoring and supportive care. Endoscopic retrograde cholangiopancreatography (ERCP) was scheduled for stone removal and biliary decompression. Patient counseled on continued alcohol abstinence and referred to addiction medicine services. Nutritional supplementation with thiamine and multivitamins initiated. Close monitoring of liver function tests and biliary enzymes planned.

Outcome and Follow-up

Patient successfully underwent ERCP with stone extraction and sphincterotomy. Symptoms of pale stools and abdominal pain resolved post-procedure. Patient maintained sobriety with support from addiction counseling services and peer support groups. Follow-up appointments scheduled with gastroenterology and addiction medicine. Liver function tests showed gradual improvement over subsequent months with continued abstinence.