system
Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response.
user
A 47-year-old woman comes to the emergency department 4 hours after the onset of abdominal and right shoulder pain. She has nausea and has had 2 episodes of vomiting. The pain began after her last meal, is constant, and she describes it as 7 out of 10 in intensity. She has had multiple similar episodes over the past 4 months that resolved spontaneously. She drinks 2 pints of vodka daily. She appears ill. Her temperature is 38.4°C (101.1°F), pulse is 110/min, respirations are 20/min, and blood pressure is 165/90 mm Hg. She is alert and fully oriented. Examination shows diaphoresis and multiple telangiectasias over the trunk and back. The abdomen is distended; there is tenderness to palpation in the right upper quadrant. When the patient is asked to inhale with the examiner's hand below the costal margin in the right midclavicular line, the patient winces and her breath catches. Voluntary guarding and shifting dullness are present. The liver is palpated 3 cm below the right costal margin. Laboratory studies show:
Hemoglobin 11.5 g/dL
Leukocyte count 16,300/mm3
Platelet count 150,000/mm3
Prothrombin time 20 sec (INR=1.3)
Serum
Urea nitrogen 16 mg/dL
Glucose 185 mg/dL
Creatinine 1.2 mg/dL
Bilirubin (total) 2.1 mg/dL
Albumin 3.1 g/dL
An abdominal ultrasound shows multiple small stones in the gallbladder and fluid in the gallbladder wall with wall thickening and pericholecystic fluid and stranding. Which of the following is the most appropriate next step in management?"
assistant
Abdominal paracentesis