Acute Cholecystitis: The Daily PANCE Blueprint
A 45-year-old female presents with 12 hours of right upper quadrant abdominal pain, fever, nausea, and vomiting. The pain radiates to her right shoulder blade. What is the most appropriate initial imaging diagnostic tool?
A. Abdominal MRI
B. ERCP
C. CTA abdomen and pelvis
D. HIDA scan
E. Right upper quadrant US
Answer and topic summary
The answer is E. Right upper quadrant US
Acute cholecystitis is inflammation of the gall bladder that occurs most commonly due to a gallstone (90% of the time). Clinical features include RUQ pain, fever, malaise, nausea/emesis, pain radiation to the right scapula, and positive Murphy sign (pain and halt in inspiration during palpation of the RUQ). Labs may show mild elevations in AST and ALT; if ALP or GGT are elevated, consider cholangitis instead. RUQ transabdominal ultrasound is the preferred initial imaging test. Classically, it will show thickening of the gallbladder wall (>3 – 5 mm). Treatment includes fluids, empiric antibiotics, and a general surgery consult for evaluation for a laparoscopic cholecystectomy.
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Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint GI and Nutrition ⇒ ⇒
Also covered as part of the Emergency Medicine EOR, Internal Medicine EOR, General Surgery EOR, and Family Medicine EOR topic lists
