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Acute calculous cholecystitis — MRCEM SBA MCQ

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EasyGastrointestinal and surgical emergenciesAcute calculous cholecystitisMRCEM SBA

A 48-year-old woman presents with 18 hours of persistent right upper quadrant pain, vomiting and a temperature of 38.2°C. She has a positive Murphy’s sign and raised inflammatory markers. Ultrasound shows gallstones, gallbladder wall thickening and pericholecystic fluid; the common bile duct is not dilated. Bilirubin and other liver function tests are normal. She has no significant comorbidity and is haemodynamically stable. What is the most appropriate management plan?

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Correct answer: B — Admit for fluids, analgesia and antibiotics; arrange laparoscopic cholecystectomy within 1 week.

Persistent right upper quadrant pain, fever, a positive Murphy’s sign and inflammatory changes on ultrasound support acute calculous cholecystitis rather than uncomplicated biliary colic. She requires hospital treatment with fluids and analgesia; fever and raised inflammatory markers support antibiotic treatment. Because she is fit for surgery, NICE recommends laparoscopic cholecystectomy **within 1 week of diagnosis**. ([nhs.uk](https://www.nhs.uk/conditions/acute-cholecystitis/?utm_source=openai)) **A** offers definitive surgery but delays it beyond the recommended early window. **C** would be appropriate if common bile duct stones required clearance; normal liver function tests and a non-dilated duct do not suggest that need here. **D** is a drainage strategy for selected patients with gallbladder empyema when surgery is contraindicated and conservative management fails, not this operable patient. **E** can help investigate possible common bile duct stones when ultrasound has not shown a stone but the duct is dilated or liver function tests are abnormal. Neither indication is present. ([nice.org.uk](https://www.nice.org.uk/guidance/cg188/evidence/full-guideline-pdf-193302253))

Reference: NICE CG188: Gallstone disease: diagnosis and management (29 October 2014) — https://www.nice.org.uk/guidance/cg188/resources/gallstone-disease-diagnosis-and-initial-management-35109819418309 NICE CG188: Gallstone disease, full guideline (2014) — https://www.nice.org.uk/guidance/cg188/evidence/full-guideline-pdf-193302253 NHS: Acute cholecystitis (21 February 2023) — https://www.nhs.uk/conditions/acute-cholecystitis/