“A Lingering Ache”: Secondary Care setting
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You are a Physician Associate working in the emergency department. A 28-year-old female presents after following the advice provided in primary care. Despite receiving appropriate management, including dietary advice and safety netting, her symptoms have escalated. She reports worsening right upper quadrant pain that radiates to her right shoulder, along with nausea, fever, and chills. She appropriately attended A&E as advised.
Appearance: The patient appears visibly distressed and febrile. She reports worsening pain, chills, and sweating. She denies vomiting but notes reduced appetite.
- Pulse: 102 bpm, regular.
- Blood Pressure: 112/74 mmHg.
- Respiratory Rate: 20/min.
- Oxygen Saturation: 96% on room air.
- Temperature: 38.3°C.
- Urine Dipstick: Normal.
- Bloods:
- Raised WBC count: 14 x 10⁹/L.
- CRP: 85 mg/L (elevated).
- Liver function tests: Normal bilirubin, mild ALT and ALP elevation.
- Imaging: Abdominal ultrasound confirms multiple gallstones and a thickened gallbladder wall, suggestive of acute cholecystitis.
What is your next step in managing this patient?