Posted by armal from IP 69.22.237.93 on March 31, 2006 at 16:28:07:
A 74-year-old man with insulin-dependent diabetes mellitus and chronic renal failure comes to the emergency department because of nausea and vomiting for 24 hours. He denies any chest pain or abdominal pain. He underwent his routine hemodialysis yesterday without any complications. His temperature is 38.8 C (101.8 F), blood pressure is 120/70 mm Hg, and pulse is 110/min. Abdominal examination reveals guarding in the right upper quadrant with no tenderness or peritoneal signs. Laboratory studies show a leukocyte count of 24,000/mm3 and a serum bilirubin of 2.2 mg/dL. An ultrasound examination of the right upper quadrant reveals a gallbladder with sludge, but no stones. The most appropriate next step in the management of this patient is:
A. a CT scan of the abdomen
B. a colonoscopy
C. intravenous antibiotics and continued observation
D. a hepatobiliary scan
E. an upper gastrointestinal endoscopy