Uncomplicated

Pt presents with abdominal pain ML 2/2 cholecystitis.
No abdominal bruits, no radiation to back, no CVA tenderness, no h/o alcohol abuse, no h/o diverticula or bloody stool. Pt having flatus and nml BMs.
Pt nontoxic in appearance w nml vitals.
Unlikely AAA, pancreatitis, SBO, appendicitis, mesenteric ischemia, nephrolithiasis, pyelonephritis, or diverticulitis.

Workup: CBC, BMP + LFTs + Abdominal US

ED Interventions: NPO. IVF. Start ABX: metronidazole 500mg IV q8hrs ciprofloxacin 400mg IV q12 hrs

Disposition: Admission to General Surgery

Complicated

Pt presents with abdominal pain ML 2/2 cholecystitis. No abdominal bruits, no radiation to back, no CVA tenderness, no h/o alcohol abuse, no h/o diverticula or bloody stool. Pt having flatus and nml BMs. Unlikely AAA, pancreatitis, SBO, appendicitis, mesenteric ischemia, nephrolithiasis, pyelonephritis, or diverticulitis.

Toxic appearance with septic vitals. CBC, BMP, lipase + LFTs + Blood cultures + lactate + Abdominal US.

Plan admission to General Surgery. Pt NPO on IVF 30cc/kg and ABX: Vancomycin 15-20mg/kg, metronidazole 500mg IV q8hrs, and ciprofloxacin 400mg IV q12 hrs.

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PEARLS:

• common infectious agents
  • E.coli, Klebsiella and Enterobacter.