Question: A 42-year-old woman presents to the emergency department with severe right upper quadrant abdominal pain that began suddenly 12 hours ago. She describes the pain as constant and radiating to her right shoulder. She reports associated nausea and vomiting but denies any recent changes in bowel habits. On physical examination, she has a positive Murphy's sign. Her temperature is 101.3°F (38.5°C), heart rate is 105 beats per minute, blood pressure is 80/60 mm Hg, and oxygen saturation is 80%. Laboratory tests reveal leukocytosis with a WBC count of 15,000/mm³. An ultrasound of the right upper quadrant demonstrates gallbladder wall thickening, pericholecystic fluid, and gallstones. Blood cultures are pending. Her CT Report and Surgeon Consult are as follows: CT Abdomen and Pelvis Report      Examination: Contrast-enhanced computed tomography (CT) scan of the abdomen and pelvis.      Clinical Indication: 42-year-old female presenting with acute right upper quadrant abdominal pain, fever, leukocytosis, and ultrasound findings suggestive of acute cholecystitis. Evaluate for complications and need for emergent surgical intervention.      Technique:              Axial and multiplanar reformatted images were obtained from the diaphragm to the pelvis after the intravenous administration of iodinated contrast material.         Oral contrast was not administered.           Findings:      Gallbladder:              The gallbladder is markedly distended, measuring up to 10 cm.         There is pronounced gallbladder wall thickening of approximately _5_ mm (normal ≤3 mm).         The gallbladder wall demonstrates hyperenhancement after contrast administration.         Multiple radiodense gallstones are present within the gallbladder lumen, with one calculus impacted at the gallbladder neck/cystic duct region.         Pericholecystic fluid collections are evident surrounding the gallbladder.         There is significant inflammatory fat stranding in the pericholecystic region.         No evidence of gas within the gallbladder wall or lumen to suggest emphysematous cholecystitis.         No visible perforation or abscess formation at this time.           Biliary Tree:              The intrahepatic and extrahepatic bile ducts are not dilated.         The common bile duct measures within normal limits.           Liver:              The liver is normal in size and exhibits homogeneous attenuation.         No focal hepatic lesions are identified.         No intrahepatic biliary dilatation.           Pancreas:              The pancreas is unremarkable in size and contour.         No signs of pancreatitis or peripancreatic fluid collections.           Spleen and Adrenal Glands:              The spleen and adrenal glands appear normal without focal lesions.           Kidneys:              Both kidneys are normal in size and shape.         No evidence of hydronephrosis or nephrolithiasis.           Bowel:              The stomach and visualized bowel loops are unremarkable.         No signs of bowel obstruction or ischemia.           Peritoneum:              A small amount of free fluid is present in the peritoneal cavity, likely reactive.           Vasculature:              The abdominal aorta and its major branches are patent.         No aneurysmal dilatation or dissection.           Other Findings:              Lung bases are clear with no pleural effusions.         No free intraperitoneal air is detected.           Impression:              Findings are consistent with acute calculous cholecystitis, evidenced by gallbladder distension, marked wall thickening, hyperenhancement, pericholecystic fluid, and impacted gallstones at the gallbladder neck.         Significant inflammatory changes in the pericholecystic fat suggest ongoing infection and inflammation.         No current evidence of gallbladder perforation, emphysematous cholecystitis, or abscess formation.         Mild reactive ascites noted.                 Surgeon Consult Note:     42-year-old female presents with 12-hour onset of severe RUQ abdominal pain radiating to the right shoulder, positive Murphy's sign, temp 101.3°F, HR 105 bpm, WBC 15,000/mm³. Imaging confirms acute calculous cholecystitis with gallbladder distension, wall thickening, pericholecystic fluid, and impacted gallstone at the neck. Emergent laparoscopic cholecystectomy required—proceeding to OR immediately. IV antibiotics initiated (ceftriaxone and metronidazole), patient NPO, please optimize overall cardiopulmonary status, informed consent obtained.     Which of the following is the best next step here?
A. Administer broad-spectrum antibiotics and observe
B. Provide oxygen
C. Perform outpatient percutaneous cholecystostomy
D. Perform emergent cholecystectomy
E. Initiate intravenous fluids and pain management
Answer: B