22nd April 2024

A 68-year-old man is admitted to hospital with a two-day history of abdominal pain and vomiting

A 68-year-old man is admitted to hospital with a two-day history of abdominal pain and vomiting. He has a past medical history of ischaemic heart disease and had percutaneous coronary intervention for a myocardial infarction 2 years ago. On examination, he looks unwell. His heart rate is 125 (atrial fibrillation), blood pressure 100/60, respiratory rate 24 and temperature 38.9 degrees. The abdomen is soft but tender over the right upper quadrant.

Bloods show the following:

He is commenced on broad spectrum antibiotics and intravenous fluids. He undergoes an abdominal ultrasound, which demonstrates sludge in the gallbladder and a dilated common bile duct (12mm). He has responded well to intravenous fluids and antibiotics. Blood pressure is now 125/85 and heart rate is now 99 bpm. He is passing acceptable hourly volumes of urine.

What is the next most appropriate next step in the management of this patient?

Select the SINGLE most appropriate option from the list below. Select ONE option only.