Right upper quadrant abdominal pain

A 45-year-old female presents with right upper quadrant abdominal pain that radiates to her right shoulder. She also complains of nausea and vomiting, especially after consuming fatty meals. On examination, there is right upper quadrant tenderness and Murphy's sign is positive. Laboratory tests show elevated liver enzymes and a white blood cell count within the normal range. What is the most appropriate initial management?

A. Immediate cholecystectomy B. Administer intravenous (IV) antibiotics

C. Order an ultrasound of the abdomen D. Perform a magnetic resonance cholangiopancreatography (MRCP) E. Administer oral antibiotics and observe

Answer: C. Order an ultrasound of the abdomen

Explanation: This patient's presentation with right upper quadrant pain, Murphy's sign, and nausea/vomiting is suggestive of cholecystitis, likely due to gallstones. The initial diagnostic test of choice is an ultrasound of the abdomen to confirm the diagnosis. While cholecystectomy is often indicated for cholecystitis, it can be planned after confirmation of the diagnosis. Antibiotics are not a substitute for definitive surgical management. MRCP may be considered if common bile duct stones are suspected.