American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the initial treatment approach for patients with acute cholecystitis?

1. Oral antibiotics followed by surgery

2. Intravenous antibiotics and surgical consultation

3. Observation and dietary management

4. Immediate laparotomy

The correct answer is: Intravenous antibiotics and surgical consultation

The initial treatment approach for acute cholecystitis focuses on addressing both the infection and the need for surgical intervention. Intravenous antibiotics are essential for managing the infection associated with the inflamed gallbladder. They help to control any bacterial growth and prevent systemic complications. Additionally, a surgical consultation is vital to evaluate the patient for potential cholecystectomy, which is often performed as soon as the patient's condition is stabilized. The choice of intravenous antibiotics is crucial because oral antibiotics may not provide adequate coverage in the setting of acute abdominal conditions where the patient's gastrointestinal tract may not be functioning optimally. Surgical intervention is typically recommended within 24 to 48 hours of diagnosis, depending on the patient's clinical status, to reduce the risk of complications such as perforation of the gallbladder. Observation and dietary management do not address the underlying inflammatory process effectively and can lead to worsening of the patient's condition. Immediate laparotomy is generally reserved for cases with complications like perforation or abscess formation and is not the standard initial approach for uncomplicated acute cholecystitis. Therefore, the combination of intravenous antibiotics and surgical consultation represents the appropriate and timely management for patients presenting with acute cholecystitis.