Cholecystitis

A 45-year-old female presents to the clinic with right upper quadrant pain, fever, and nausea for three days. She has a history of gallstones. On physical examination, she has tenderness in the right upper quadrant with a positive Murphy’s sign. Laboratory tests reveal leukocytosis and elevated C-reactive protein.

What is the primary pathophysiological mechanism of acute cholecystitis?

A 65-year-old woman with a history of type 2 diabetes presents to the emergency department with severe right upper quadrant pain, fever, and chills. She has had similar, but less severe, episodes of pain in the past. On examination, she has a positive Murphy’s sign and marked tenderness in the right upper quadrant. Her observations are: heart rate 110 bpm, respiratory rate 24 breaths per minute, blood pressure 135/90 mmHg, and temperature 38.5C. Laboratory tests show leukocytosis, elevated liver enzymes, and an elevated C-reactive protein. An ultrasound shows a distended gallbladder with gallstones and thickened walls, and no biliary duct dilation.

What is the definitive treatment for this condition?

A 70-year-old man presents with right upper quadrant pain, fever, and jaundice. He has a history of gallstones and has experienced similar, less severe episodes of pain. On examination, he is febrile and jaundiced, with tenderness in the right upper quadrant and a positive Murphy’s sign. His observations are: heart rate 105 bpm, respiratory rate 20 breaths per minute, blood pressure 140/85 mmHg, and temperature 38.4C. Laboratory tests reveal elevated white blood cell count, elevated bilirubin, and elevated alkaline phosphatase. An ultrasound shows a thickened gallbladder wall, gallstones, and a dilated common bile duct.

What is the most likely complication in this patient?

A 50-year-old woman presents with severe right upper quadrant pain, fever, and nausea. The pain started several hours after eating a fatty meal. Ultrasound shows gallbladder wall thickening and pericholecystic fluid.

What is the most likely diagnosis?

A 48-year-old man presents with right upper quadrant pain, fever, and vomiting that started 18 hours ago. He describes the pain as sharp and constant, radiating to his back. He has a history of gallstones and previously experienced mild episodes of abdominal pain. On examination, he has a positive Murphy’s sign and tenderness in the right upper quadrant. His observations are: heart rate 100 bpm, respiratory rate 22 breaths per minute, blood pressure 125/80 mmHg, and temperature 38.2C. Laboratory tests show elevated white blood cell count and mild elevation of bilirubin. An abdominal ultrasound confirms the presence of gallstones and a thickened gallbladder wall.

What is the initial management for this patient?