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)
acute cholecystitis
b
in the question itself r/o cholecycstitis. I think it is acute colangitis b;cos very high wbc count. should check ALP and high fever in history.
answer is probably A to decompress billiary system.
c
bbbbbb
An MRCP is usually done but if it is neg—it doesnt rule out cholelithiasis. An ERCP is more specific Surgery is too aggressive right now. Lets test for obstruction–ercp
b