My patient’s symptoms are consistent with biliary dysfunction (right-upper-quadrant pain after eating), and an N-para-isopropyl-acetanilide-iminodiacetic acid (PIPIDA) scan shows mild dysfunction. An abdominal ultrasound, however, is negative. Should he be referred to a surgeon for cholecystectomy? — DIANNE WENDLING, PA-C, Burnt Hills, N.Y.

Given your description, I would consider a diagnosis of acalculous cholecystitis. The walls of the gallbladder are typically thickened but not always so. Gross examination of the resected gallbladder may reveal inflammation and edematous walls. The lumen will likely be filled with sludge. Removal of the gallbladder is usually recommended. — Claire Babcock O’Connell, MPH, PA-C (145-6)