<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 58-year-old woman comes to the emergency department because of a 2-day history of worsening upper abdominal pain. She reports nausea and vomiting, and is unable to tolerate oral intake. She appears uncomfortable. Her temperature is 38.1C 100.6F, pulse is 92min, respirations are 18min, and blood pressure is 13285 mm Hg. Examination shows yellowish discoloration of her sclera. Her abdomen is tender in the right upper quadrant. There is no abdominal distention or organomegaly. Laboratory studies show:Hemoglobin 13 gdLLeukocyte count 16,000mm3SerumUrea nitrogen25 mgdLCreatinine 2 mgdLAlkaline phosphatase 432 ULAlanine aminotransferase 196 ULAspartate transaminase 207 ULBilirubinTotal 3.8 mgdLDirect 2.7 mgdLLipase 82 UL N 14280Ultrasound of the right upper quadrant shows dilated intrahepatic and extrahepatic bile ducts and multiple hyperechoic spheres within the gallbladder. The pancreas is not well visualized. Intravenous fluid resuscitation and antibiotic therapy with ceftriaxone and metronidazole is begun. Twelve hours later, the patient appears acutely ill and is not oriented to time. Her temperature is 39.1C 102.4F, pulse is 105min, respirations are 22min, and blood pressure is 11282 mm Hg. Which of the following is the most appropriate next step in management?? A: Abdominal CT scan, B: Laparoscopic cholecystectomy, C: Percutaneous cholecystostomy, D: Extracorporeal shock wave lithotripsy, E: Endoscopic retrograde cholangiopancreatographyn,  <response>: This is a clinical vignette describing a 58-year-old woman with worsening upper abdominal pain, nausea, vomiting, scleral icterus, right upper quadrant tenderness, elevated liver enzymes and bilirubin, dilated bile ducts, and gallstones on ultrasound. She is acutely ill 12 hours after starting antibiotic therapy.The key findings are:- Acute cholecystitis based on clinical presentation and ultrasound findings- Worsening sepsis despite antibiotic therapy - Obstructive jaundice from gallstone impaction in the common bile ductThe most appropriate next step is to relieve the biliary obstruction. Endoscopic retrograde cholangiopancreatography ERCP allows visualization of the biliary system and removal of obstructing gallstones. This is preferable to surgery in an acutely ill septic patient. CT scan, cholecystectomy, cholecystostomy, and lithotripsy do not address the biliary obstruction.E: Endoscopic retrograde cholangiopancreatography 