bobby
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A 51-year-old man presents to the emergency department with abdominal pain. He was well until 2 days ago, when he began to experience severe right upper quadrant pain, radiating to the epigastric region. He reports temperatures to 38.3 C (101 F) and some nausea and vomiting. His temperature is now 39.1 C (102.3 F), blood pressure is 130/70 mm Hg, and pulse is 90/min. Physical examination reveals tenderness in his right upper quadrant, with abrupt cessation of inspiration on deep palpation of his right upper quadrant. Which of the following is the most appropriate management for this patient?
A. IV fluids and observation
B. IV antibiotics and observation
C. Admission to a surgical service for next day surgery
D. Urgent surgical evaluation for immediate surgery
E. Urgent percutaneous drainage
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| chemamr
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ok, if you have this question and only these answers:
i go with D (maybe start with a laparoscopic cholecystectomy, but probably it would convert into an open one).
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| drkpp
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i thinki its B. looks like acute cholecystitis so conservative RX...
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| intern_doc
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I think it's A
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| chemamr
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which is the answer and why bobby?
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| merrk
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C. Acute cholecytitis. Admit patient, IV hydration, NPO, analgesia, Abx, and prepare him for surgery the next day. Surgery is not urgent, it is elective. There is no benefit in delaying surgery either (i.e. till inflammation resolves) and the practice is to do surgery at the time of admission after bowel prep (i.e. pt NPO)
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| chemamr
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here you have. A, B, C, D. 
i think itīs because the management is controversial. Some use antibiotics and some surgeons donīt. And the timing of surgery is controversial, too, some do it at the same day or the next day and there are also others who do it in a delayed approach, even 2 -3 months later. But it seems to be that the early surgery is better, and if the patient has less than 48 hours since the beginnning of this acute process, many attempt a laparoscopical cholecystectomy or open.
Which is the answer bobby?
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| tamar
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D.fever has increased,
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| bobby
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merrk wrote:
C. Acute cholecytitis. Admit patient, IV hydration, NPO, analgesia, Abx, and prepare him for surgery the next day. Surgery is not urgent, it is elective. There is no benefit in delaying surgery either (i.e. till inflammation resolves) and the practice is to do surgery at the time of admission after bowel prep (i.e. pt NPO)
correct ans given is C.
thanx merrk for that explanation.
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| chemamr
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i think really this question is not straight forward. But, itīs ok. C.
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| mani
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there r many schools of thought on management of cholecystitis and i dont expect a question like this on the exam
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| chemamr
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thatīs what i mean Mani, i agree with you. Itīs a controversial topic. But itīs only a question of a qbank. Ok. 
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