American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the recommended management for acalculous cholecystitis?

1. High-dose opioid analgesia

2. Supportive treatment with antibiotic coverage

3. Immediate surgical intervention

4. Observation without intervention

The correct answer is: Supportive treatment with antibiotic coverage

The recommended management for acalculous cholecystitis is supportive treatment with antibiotic coverage. Acalculous cholecystitis, which occurs without the presence of gallstones, is often seen in critically ill patients and can be associated with various conditions, such as sepsis or prolonged fasting. The immediate approach focuses on addressing the underlying conditions and providing supportive care. Antibiotic therapy is essential in managing this condition because it helps combat any pre-existing infections, which can be pivotal in patients who are already at a higher risk due to their critical status. The use of antibiotics can help stabilize the patient's condition and reduce the risk of complications that can arise from the inflammation of the gallbladder. In many cases of acalculous cholecystitis, surgical intervention may still be necessary, especially if the patient does not respond to medical management. However, this often occurs after initial stabilization with antibiotics and supportive care. Immediate surgical intervention as the first-line approach is not typically favored due to the potential risks associated with surgery in critically ill patients. Additionally, observation without intervention is generally not appropriate, as it fails to address the infection and potential complications that can arise from the inflamed gallbladder. High-dose opioid analgesia may be