Fried snickers and gallstones

A 36 year old female from Wisconsin presents to the ED for abdominal pain. It's late summer and she is really excited to take her 2 children to the Minnesota State Fair (the 2nd largest state fair in the country) over memorial day weekend to enjoy favorites like turkey legs, Sweet Martha's Cookies and battered deep-fried snickers on a stick. Like the other 2 million people there, she attends the fair and chows down. 30 minutes after eating her deep-fried snickers on a stick, she begins having some cramping abdominal pain on her right side. It has happened before, but usually goes away. After 2 days or so of this pain, she decides to go to an urgent care because it has made her real nauseous and caused her to vomit. On exam, she is febrile and BP 90/70. She is extremely uncomfortable. A RUQ US is performed but the report states it is limited due to “overlying bowel gas”. Which of the following is correct?

A) Elevations in ALT and AST are common in cholecystitis

B) This patient should undergo emergent cholecystectomy
C) Patients with biliary colic should be made NPO and treated with IVF and IV Abx
D) Piperacillin-tazobactam is the Antibiotic of choice for biliary pathology requiring surgery

E) Physical exam findings are sufficient to establish the diagnosis of cholecystitis

——-References:

Williams, D. Gallbladder. Retrieved September 16, 2018, from https://onlinemeded.org/spa/gastroenterology/gallbladder/

Zakko, SF, Afdhal, NH. Acute Cholecystitis: Pathogenesis, clinical features, and diagnosis. UpToDate.Waltham, MA: UpToDate Inc. https://www.uptodate.com/contents/acute-cholecystitis-pathogenesis-clinical-features-and-diagnosis (Accessed on September 17, 2018.)
Zakko, SF. Overview of gallstone disease in adults. UpToDate.Waltham, MA: UpToDate Inc. https://www.uptodate.com/contents/overview-of-gallstone-disease-in-adults (Accessed on September 17, 2018.)

Blake Briggs