Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with acute onset of right upper quadrant (RUQ) abdominal pain, often in the setting of critical illness, recent major surgery, or prolonged fasting. Symptoms include nausea, vomiting, and fever. Absence of biliary colic history. Clinical suspicion high for gallbladder inflammation in the absence of cholelithiasis.
Clinical Examination Findings
Abdominal examination reveals localized tenderness in the RUQ. Murphy’s sign may be equivocal or absent due to patient sedation or underlying critical condition. Signs of systemic inflammatory response syndrome (SIRS) such as tachycardia, tachypnea, and fever are frequently noted. Abdominal distension or guarding may be present.
Treatment Protocol
Immediate stabilization with fluid resuscitation and broad-spectrum intravenous antibiotics. Urgent surgical consultation for cholecystectomy or percutaneous cholecystostomy tube placement if the patient is deemed too unstable for surgery. Serial monitoring of inflammatory markers and abdominal imaging.