A 52-year-old woman comes to the emergency department because of epigastric abdominal pain that started after her last meal and has become progressively worse over the past 6 hours. She has had intermittent pain similar to this before, but it has never lasted this long. Her temperature is 39°C (102.2°F). Examination shows a soft abdomen with normal bowel sounds. The patient has sudden inspiratory arrest during right upper quadrant palpation. Laboratory assessment shows a serum bilirubin of 0.8 mg/dL and a serum alkaline phosphatase of 100 U/L. Which of the following diagnostic test results would be most specific for acute cholecystitis?

Question

A 52-year-old woman comes to the emergency department because of epigastric abdominal pain that started after her last meal and has become progressively worse over the past 6 hours. She has had intermittent pain similar to this before, but it has never lasted this long. Her temperature is 39°C (102.2°F). Examination shows a soft abdomen with normal bowel sounds. The patient has sudden inspiratory arrest during right upper quadrant palpation. Laboratory assessment shows a serum bilirubin of 0.8 mg/dL and a serum alkaline phosphatase of 100 U/L.  Which of the following diagnostic test results would be most specific for acute cholecystitis?

Quizplus · Accepted Answer

Eductional Objective: Acute cholecystitis is most often caused by gallstones obstructing the cystic duct.  The diagnosis can be made by identifying signs of gallbladder inflammation (eg, wall thickening, pericholecystic fluid) on ultrasonography.  When ultrasound is inconclusive, nuclear medicine hepatobiliary scanning (ie, cholescintigraphy) can be used to assess cystic duct patency and make the diagnosis.

A 52-Year-Old Woman Comes to the Emergency Department Because of Epigastric