Q88). A 75 year old woman is sent from the nursing home for evaluation of fever and altered mental status. The patient’s past medical history is significant for moderate Alzheimer’s dementia. On examination, she is confused. Her vitals reveal Temperature of 102F, Blood pressure 80/60 and a HR of 102/min. Chest and cardiovascular examination is benign. On abdominal examination, the patient moans upon palpation of right upper quadrant. Cholecystitis is suspected and ultrasound is obtained that reveals very distended gall bladder with pericholecystic fluid, a normal caliber common bile duct and a gall stone in the cystic duct. The patient is started on IV Normal saline and broad spectrum antibiotics. Her blood pressure despite initial hydration is still 80/40. She is started on Norepinephrine drip. The next most important step in managing this patient ?
A. Urgent Cholecystectomy
B. Endoscopic Retrograde Cholangiopancreatography
C. Percutaneous Cholecystostomy
D. 2D echocardiogram
E. Exploratory Laporotomy
B
b
C?
This is an emergency
u must releive the distention NOW
C is the answer
the stone is in the cystic not in choledoco them you hace to take out the gb and check the cystic to take out the stone, if the stone where in choledoco, choledocolytiasis them ercp
why is the answer C?
ans A
A – A case of complicated Acute Cholecystitis. In view of Pericholecystic Ascites, there is no more time left for further investigations except to Open & do Cholecystectomy asap. Following are the signs of Complicated AC – pericholecystic fluid collection, intramural gas within GB, any disruption or sloughed GB mucosa on USG
are wah
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