Posted by AN from IP 24.207.254.38 on April 01, 2006 at 09:29:04:
In Reply to: q posted by armal on March 31, 2006 at 16:28:07:
Fever,gaurding at Rt.upper quadrant,hyperbilirubinemia suggests the possibility of either cholicystitis(acalculous) or cholangitis(charcot's triad). I think cholicystitis can be easily ruled out by the absence of tenderness, peritoneal signs on clinical exam and on ultrasound examination. It should have shown gall bladder wall thickening, pericholicystic fluid collection, distended bladder if it is cholicystitis. lack of these features favours early cholangitis in this case.As there are no features of biliary dilatation we can give antibiotics and observation. If we are thinking in terms of cholicystitis or cholangitis, CT scan and endoscopies are not much useful. hepatobiliary scan is indicated if acalculous cholicystitis is a strong possibility. which is unlikely based on the features of ultrasound examination that already done in this case. So I favour IV antibiotics in this case.