A 45-year-old female presents to the emergency department with a 24-hour history of sharp, right upper quadrant abdominal pain radiating to her right shoulder, nausea, and fever. Her vitals are: BP 135/85 mmHg, HR 102 bpm, RR 19/min, Temp 101.3°F (38.5°C), and SpO2 97% on room air. On examination, you note a positive Murphy's sign. Laboratory results show a mild leukocytosis. Suspecting cholecystitis, what is the most appropriate initial diagnostic test to order?
Right upper quadrant ultrasound
Hepatobiliary (HIDA) scan
Abdominal CT scan
Magnetic resonance cholangiopancreatography (MRCP)
A right upper quadrant ultrasound is the most appropriate initial diagnostic test for suspected cholecystitis. It is highly sensitive and specific for detecting gallstones, biliary sludge, gallbladder wall thickening, and pericholecystic fluid, which are indicative of cholecystitis. An abdominal CT scan may be useful for assessing complications or alternative diagnoses but is not the first-line imaging modality for cholecystitis. A hepatobiliary (HIDA) scan is typically reserved for cases where the diagnosis is uncertain after ultrasound. MRCP is also used in complex cases or when further biliary tree assessment is needed, but not as the initial test.
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BCEN CEN
Gastrointestinal, Genitourinary, Gynecology, and Obstetrical
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