A 43-year-old with fever, jaundice and right upper quadrant pain becomes confused. BP 92/58, bilirubin 84 µmol/L, ALP 360 U/L, WBC 19, and ultrasound

Question

A 43-year-old with fever, jaundice and right upper quadrant pain becomes confused. BP 92/58, bilirubin 84 µmol/L, ALP 360 U/L, WBC 19, and ultrasound shows a dilated common bile duct. What is the most appropriate initial management?

Accepted Answer

Broad-spectrum antibiotics, resuscitation, and urgent biliary decompression

Answer

Observation until bilirubin doubles

Answer

Oral analgesia and discharge after fever settles

Answer

Steroids for presumed autoimmune hepatitis

Answer

Elective outpatient cholecystectomy referral

Ascending cholangitis — RCPSC EM MCQ

A 43-year-old with fever, jaundice and right upper quadrant pain becomes confused. BP 92/58, bilirubin 84 µmol/L, ALP 360 U/L, WBC 19, and ultrasound shows a dilated common bile duct. What is the most appropriate initial management?