What is the next best step in management for suspected cholecystitis with RUQ pain, fever, and leukocytosis?

• A. Surgical intervention
• B. Administration of antibiotics
• C. RUQ ultrasound
• D. CT abdomen

Answer: (C)

In a case of suspected cholecystitis characterized by right upper quadrant (RUQ) pain, fever, and leukocytosis, the immediate next step in management is to obtain imaging to confirm the diagnosis. An RUQ ultrasound is the preferred initial imaging modality because it is non-invasive, does not involve radiation, and is excellent at visualizing gallbladder inflammation, stones, and possible complications such as abscesses or perforation.

By performing the RUQ ultrasound, you can assess for signs of cholecystitis, including thickening of the gallbladder wall, presence of gallstones, and pericholecystic fluid. Confirming the diagnosis through imaging is crucial as it guides further management, including the timing and type of surgical intervention.

While administering antibiotics is a vital part of managing cholecystitis and will usually occur after the diagnosis has been confirmed, it should follow imaging results. Surgical intervention may be necessary if cholecystitis is confirmed, but definitive surgery is typically postponed until the diagnosis is established through appropriate imaging. A CT scan of the abdomen can also be utilized but is generally not the first choice for suspected biliary pathology due to the higher exposure to radiation and lesser specificity for gall