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Acute cholecystitis — MCCQE Part 1 MCQ

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ModerateAbdominal PainAcute cholecystitisMCCQE Part 1

A 44-year-old woman presents with right upper-quadrant pain lasting 14 hours, fever and nausea. Murphy sign is positive, white blood cell count is 15 × 10^9/L, and ultrasound shows gallstones with gallbladder wall thickening. What is the most appropriate next step in management?

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Correct answer: E — Admit for antibiotics, analgesia and early laparoscopic cholecystectomy

Persistent right upper-quadrant pain, fever, leukocytosis and ultrasound evidence of gallbladder inflammation indicate acute cholecystitis, usually requiring admission, antibiotics and early cholecystectomy. ERCP is indicated when common bile duct obstruction or cholangitis is suspected. Ursodeoxycholic acid is not definitive acute management.

Reference: Canadian Association of General Surgeons resources; Tokyo Guidelines