A -year-old female presents to the emergency department with a two-day history of intermittent, severe right upper quadrant abdominal pain that radiates to her right shoulder. She also reports nausea and multiple episodes of non-bilious vomiting. On physical examination, her temperature is C ( F), blood pressure is mmHg, heart rate is /min, and respiratory rate is /min. She has scleral icterus and localized tenderness to palpation in the right upper quadrant without rebound or guarding. Laboratory studies reveal:
White blood cell count: /mm
Total bilirubin: mg/dL
Direct bilirubin: mg/dL
Aspartate aminotransferase (AST): U/L
Alanine aminotransferase (ALT): U/L
Alkaline phosphatase: U/L
A transabdominal ultrasound demonstrates cholelithiasis and a common bile duct measuring mm in diameter. No echogenic shadowing structures are visualized within the common bile duct. Which of the following is the most appropriate next step in the diagnostic workup of this patient?
- Magnetic resonance cholangiopancreatographyAnswer
- BEndoscopic retrograde cholangiopancreatography
- CComputed tomography of the abdomen with intravenous contrast
- DHepatobiliary iminodiacetic acid (HIDA) scan
- EPercutaneous transhepatic cholangiography