A 35-year-old otherwise healthy female status post Roux-en-Y gastric bypass surgery presents to the ICU with abdominal pain mainly in the epigastric region with temperature of 101.5°F, blood pressure of 84/60 mm Hg with altered mental status after 4 L of crystalloid in the ED. A CT scan that does not demonstrate any bowel obstruction or internal hernia however a mildly dilated common bile duct with gallstones is visualized without signs of cholecystitis. On examination, she is jaundiced with epigastric tenderness to palpation. She has a slight elevation in her AST and ALT and direct bilirubin of 5 mg/dL. Aside from appropriate intensive care resuscitation, what is the next BEST step in the management of this patient?
A. IV antibiotics and emergent surgical and gastroenterology consultation Correct Choice
B. IV antibiotics, MRCP, and consult to interventional radiology Wrong Choice!
C. Stat bedside right upper quadrant ultrasound Wrong Choice!
D. Stat head CT for altered mental status and ammonia laboratory test results Wrong Choice!
Answer:A
A 35-year-old otherwise healthy female status post Roux-en-Y gastric bypass surgery presents to the ICU with abdominal pain mainly in the epigastric region with temperature of 101.5°F, blood pressure of 84/60 mm Hg with altered mental status after 4 L of crystalloid in the ED. A CT scan that does not demonstrate any bowel obstruction or internal hernia however a mildly dilated common bile duct with gallstones is visualized without signs of cholecystitis. On examination, she is jaundiced with epigastric tenderness to palpation. She has a slight elevation in her AST and ALT and direct bilirubin of 5 mg/dL. Aside from appropriate intensive care resuscitation, what is the next BEST step in the management of this patient?
A. IV antibiotics and emergent surgical and gastroenterology consultation Correct Choice B. IV antibiotics, MRCP, and consult to interventional radiology Wrong Choice! C. Stat bedside right upper quadrant ultrasound Wrong Choice! D. Stat head CT for altered mental status and ammonia laboratory test results Wrong Choice!