Question: A 23-year-old woman with a history of acid reflux, trichotillomania and trichophagia with reported last ingestion four years prior presented with a three week history of postprandial epigastric and right upper quadrant pain, nausea and vomiting. She denied fevers, chills, melena or hematochezia. Vital signs were within normal limits. Abdominal exam was notable for mild tenderness at the epigastrium with negative Murphy’s sign. Blood chemistry, complete blood count, and liver function tests were normal.