Patient case: Acute Cholecystitis
A 45-year-old female presents to the emergency department with severe, sharp pain in the upper right quadrant of her abdomen that started 12 hours ago. The pain radiates to her right shoulder and worsens after eating a fatty meal. She also reports nausea, vomiting, and a low-grade fever. She denies any changes in bowel habits or urinary symptoms.
On physical examination, the patient is febrile (38.5°C) and in visible discomfort. There is tenderness in the right upper quadrant with a positive Murphy’s sign. Laboratory tests reveal an elevated white blood cell count and mildly elevated liver enzymes. An abdominal ultrasound shows gallbladder wall thickening, distended gallbladder, and gallstones, consistent with acute cholecystitis.
The patient is admitted to the hospital and started on intravenous fluids, antibiotics, and pain management. After stabilization, she is scheduled for laparoscopic cholecystectomy to remove the inflamed gallbladder. The patient is educated about the procedure, and the surgery is planned for the next day.
a). Lower abdominal pain
b). Severe right upper quadrant pain radiating to the right shoulder
c). Chest pain
d). Lower back pain
a). Positive Murphy's sign
b). Rebound tenderness
c). Cullen's sign
d). Fluid wave in the abdomen
a). MRI of the abdomen
b). Abdominal ultrasound
c). CT scan of the abdomen
d). Abdominal X-ray
a). Conservative management with painkillers
b). Intravenous fluids and antibiotics, followed by laparoscopic cholecystectomy
c). Endoscopic retrograde cholangiopancreatography (ERCP)
d). Dietary changes and observation
