Assessment of Acute cholecystitis: Video, Anatomy & Definition | Osmosis

Question

A 42-year-old woman, gravida 3 para 3, is brought to the emergency department due to severe abdominal pain that started 3 hours ago. She describes the pain as sharp, constant, and rates it as 7/10 in intensity. Since the pain started, she has been feeling nauseous and has vomited twice. She reports a few episodes of similar abdominal discomfort in the past but says that this time it “feels different.” Temperature is 38.0°C (100.4°F), pulse is 80/min, and blood pressure is 135/85 mmHg. BMI is 32 kg/m². The patient is in acute distress due to pain and points to the upper abdomen. The abdomen is tender to touch. No rebound tenderness or hepatomegaly is present. An abdominal ultrasound is performed and reveals a normal common bile duct with concomitant gallbladder wall thickening and free fluid around the gallbladder. Laboratory results are obtained and shown below:

Laboratory value	Result
Hemoglobin	14 g/dL
Leukocyte count	15,000 mm³
Platelet count	250,000 mm³
Mean corpuscular volume	90 μm³
Serum
Creatinine	0.8 g/dL
BUN	11 mg/dL
Bilirubin
Total	0.8 mg/dL
Direct	0.2 mg/dL
Alanine aminotransferase	18 U/L
Aspartate aminotransferase	20 U/L
Amylase	55 U/L
Lipase	62 U/L
Alkaline phosphatase	65 U/L

Which of the following is the most likely diagnosis?

Accepted Answer

Calculous cholecystitis&#160;

Answer

Choledocholithiasis&#160;

Answer

Pancreatitis&#160;

Answer

Appendicitis&#160;

Answer

Gallstone ileus

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Acute cholecystitis

Pathology

Gastrointestinal system