Question

A 47-year-old man presents with a 6-month history of intermittent abdominal pain. He notes that his episodes of pain developed after eating large amounts at holiday parties or work events. During episodes, his pain is located in the right upper quadrant without radiation, is described as sharp, and is accompanied by nausea. He is currently pain free. On examination, his abdomen is soft, nontender, and nondistended. He is afebrile. Labs are as follows:

WBC: 6.24
Hemoglobin: 16.8
Hematocrit: 49.6
Platelets: 187
Bilirubin total: 1.4
Alkaline phosphatase: 48
AST: 14
Glucose: 95
BUN: 8
Creatinine: 1.03
Sodium: 143
Potassium: 3.7
Chloride: 105
CO2: 30
ALT: 11

An abdominal ultrasound shows the presence of multiple gallstones with some sludge. The common duct is normal. There is no pericholecystic fluid present. No sonographic Murphy's sign is detected.

What is the proper course of action?
1. Oral antibiotics
2. Admission to the hospital for IV antibiotics
3. Admission to the hospital for immediate laparoscopic cholecystectomy
4. Referral to a surgeon for elective laparoscopic cholecystectomy
5. Referral to a surgeon for ERCP

Answer 1

Referral to a surgeon for elective laparoscopic cholecystectomy is the proper course of action for a 47-year-old man with intermittent abdominal pain and multiple gallstones.

Step-by-step explanation:

The proper course of action for a 47-year-old man presenting with intermittent abdominal pain, multiple gallstones, and no signs of cholecystitis or cholangitis is referral to a surgeon for elective laparoscopic cholecystectomy. In this case, there is no indication for immediate surgery or hospital admission. The patient's symptoms and the presence of gallstones suggest that the gallbladder is the source of pain, and elective removal of the gallbladder is the recommended treatment to prevent future episodes of pain.