Examkin

Question

Difficulty: EasyOrdering Imaging Studies

A 43-year-old female presents to the emergency department complaining of severe right upper quadrant abdominal pain that began three hours ago, shortly after eating a large, high-fat meal. She reports associated nausea and one episode of vomiting. Her temperature is 38.1°C (100.6°F), blood pressure is 128/82 mmHg, and heart rate is 92/min. Physical examination reveals marked tenderness to palpation in the right upper quadrant, and the patient abruptly halts her inspiration when deep palpation is applied in this area. Laboratory studies show a mildly elevated white blood cell count. Which of the following is the most appropriate initial imaging study to establish the diagnosis?

  1. Right upper quadrant ultrasonographyAnswer
  2. B
    Computed tomography of the abdomen with intravenous contrast
  3. C
    Hepatobiliary iminodiacetic acid (HIDA) scan
  4. D
    Magnetic resonance cholangiopancreatography
  5. E
    Plain radiography of the abdomen

Answer

Right upper quadrant ultrasonography is the most appropriate initial imaging study.
The correct answer is right upper quadrant ultrasonography because it is the most sensitive, specific, and cost-effective initial imaging modality for evaluating suspected acute cholecystitis. It can readily identify gallstones, measure gallbladder wall thickness (abnormal if >3 mm), detect pericholecystic fluid, and elicit a sonographic Murphy sign.

Step-by-Step Solution

1
Identify the clinical syndrome based on the patient's presentation.
The patient has postprandial right upper quadrant pain, fever, leukocytosis, and a positive Murphy sign (inspiratory arrest on palpation), which classically indicates acute cholecystitis.
Recognizing the classic clinical triad of acute cholecystitis is essential before selecting the appropriate diagnostic test.
2
Determine the evidence-based first-line imaging modality for this specific diagnosis.
Right upper quadrant ultrasonography is the standard of care.
Ultrasound is fast, avoids ionizing radiation, and is highly sensitive for detecting gallstones, gallbladder wall thickening, and pericholecystic fluid.

Key Concept

Right upper quadrant ultrasonography is the initial diagnostic imaging study of choice for evaluating suspected acute cholecystitis.
Estimated Time:45s
Rate this question

Topics

Ordering Imaging Studies

More questions from this topic