172) A 44 year old obese woman presents with complaints of abdominal pain in the right upper quadrant that started 4 hours ago and is persistent. She has mild nausea. On physical examination, there is tenderness in right upper quadrant which increases with deep breath. Her liver function tests are normal; WBC count is 24,000/µl with neutrophilic predominance. Amylase and Lipase are with in normal limits. An ultrasound of the gall bladder reveals gall stones but there is no pericholecystic fluid or any other sonographic evidence of acute cholecystitis. Sonographic murphy’s sign is absent. The most appropriate next step in managing this patient:
A) Percutaneous Cholecystostomy
B) Laparoscopic Cholecystectomy
C) HIDA scan
D) Endoscopic Retrograde Cholangiopancreatography (ERCP)
E) Magnetic Resonance CholangiOpancreatography ( MRCP)
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C
B
B
Acute cholecystitis is a clinical diagnosis
Cholelithiasis causing biliary colic
symptomatic cholelithiasis –>Laproscopic cholecystectomy
Ans: C: if Ultrasound shows NO evedience of pericholecystic fluid or chlecystitis in pt with RUQ pain. therefore, RUQ pain could be due to anything, thus, next step is HIDA to findout the EF of gallbladder. if confirmed then next step, post antibiotic rx and NPO is Surgery.
C:)