Question

A 38-year-old man presents with severe epigastric pain radiating to the back, vomiting and fever. Serum lipase is markedly elevated. Ultrasound shows gallstones and no biliary duct dilatation. He is tachycardic but haemodynamically stable. What is the most appropriate initial management?

Accepted Answer

Aggressive intravenous fluid resuscitation, analgesia and bowel rest

Answer

Immediate ERCP to remove gallstones

Answer

Start broad-spectrum antibiotics for presumed infection

Answer

Discharge home on oral analgesia and low-fat diet

Answer

Schedule urgent cholecystectomy within 12 hours without further assessment

Practice question

A 38-year-old man presents with severe epigastric pain radiating to the back, vomiting and fever. Serum lipase is markedly elevated. Ultrasound shows gallstones and no biliary duct dilatation. He is tachycardic but haemodynamically stable. What is the most appropriate initial management?