QuestionSBA
QuestionChoice
This is typically delayed until all symptoms have resolved and ERCP has confirmed that the bile duct is clear of gallstones.
10035583
b
Cholecystectomy
QuestionChoice
This is correct. The patient has features of ascending cholangitis with Charcot's triad of fever, jaundice and right upper quadrant pain. She has presented in shock and will likely require biliary drainage via ERCP alongside IV antibiotics.
10035582
a
Endoscopic retrograde cholangiopancreatography
QuestionChoice
This may be required as cases of ascending cholangitis are associated with high morbidity and mortality but the priority is in providing relief of biliary obstruction.
10035585
d
Admit to the intensive care unit
QuestionChoice
This is inappropriate as the patient is extremely unwell and requires intravenous antibiotics and relief of biliary obstruction.
10035586
e
Reassurance and discharge with oral antibiotics
QuestionChoice
The preferred approach is endoscopic as opposed to surgical.
10035584
c
Urgent laparotomy
Concept
Chapter
2693
4652
Ascending cholangitis
Topic
136
Gastroenterology
19520
Emergency endoscopic retrograde cholangiopancreatography (within 24 hours) is needed for adults with common bile duct stones and acute cholangitis or acute pancreatitis when indicated
A 47-year-old woman attends the emergency department with severe right upper abdominal pain. She is hypotensive, tachycardic, jaundiced and febrile on examination. She is fluid resuscitated and initiated on intravenous antibiotics.

What is the most appropriate management?
a