QuestionSBA
QuestionChoice
This patient has acute cholecystitis. As per NICE Guidelines, they should have a 'hot' cholecystectomy; i.e. gallbladder removal within a week of diagnosis. Delayed or 'interval' cholecystectomies are sometimes carried out as 'hot' cholecystectomies are more technically challenging and require more expertise. This may also be required if the patient requires medical stabilisation (e.g. if they are in septic shock), or optimisation of other comorbidities.
10035403
b
Cholecystectomy in 2 months' time
QuestionChoice
These will be required, however, the question asks what the definitive management for acute cholecystitis is, which is a cholecystectomy.
10035406
e
Antibiotics, fluids, and analgesia
QuestionChoice
ERCP is a useful diagnostic and therapeutic procedure for disorders of the biliary tree, e.g. ascending cholangitis. This patient has acute cholecystitis, which an ERCP will not be able to treat. They require a cholecystectomy.
10035405
d
Endoscopic retrograde cholangiopancreatography (ERCP)
QuestionChoice
This patient has acute cholecystitis. Cholecystostomy (a drain placed into the gallbladder) can be considered in patients who are not fit for surgery and do not respond to conservative management (e.g. antibiotics). This patient has no contraindications to having a cholecystectomy, and therefore this would be the best definitive management.
10035404
c
Cholecystostomy
QuestionChoice
This patient has acute cholecystitis. As per NICE Guidelines, they should have a 'hot' cholecystectomy; i.e. gallbladder removal within a week of diagnosis.
10035402
a
Cholecystectomy within 1 week
Concept
Chapter
2693
5978
Cholecystitis
Topic
135
General surgery
19484
Laparoscopic cholecystectomy should be performed within 1 week of acute cholecystitis diagnosis; if not possible, surgery should be delayed until the acute episode resolves, usually more than 4 weeks after diagnosis.
A 56-year-old man is admitted to hospital with right upper quadrant pain and fevers. An ultrasound is performed which shows multiple gallstones present within a thickened gallbladder. Has localised peritonism in the right upper quadrant and is Murphy's sign positive.

What is the most appropriate definitive management for this patient?
a