Laboratory Studies Patients have leukocytosis that is markedly high sometimes Liver transaminases...

Laboratory Studies• Patients have leukocytosis that is markedly high

sometimes• Liver transaminases are typically normal or

slightly elevated, reflecting the patient's febrile state

• Very abnormal liver test results (in particular, ALP, bilirubin, or GGTP) suggest a common duct obstruction or intrahepatic disease

• Urinalysis, chest radiograph, and electrocardiogram—obtained as part of the patient’s preoperative assessment

Imaging Studies

Abdominal Radiograph

• gallbladder lumen/wall/pericholecystic tissues contains gas

• upright view of the abdomen demonstrates air-fluid levels in the gallbladder

Imaging Studies

CT scan• Air in the

lumen of the gallbladder

• Thickened wall of the gallbladder

Management

• Medications are used to control infection and manage comorbidities – The 3 most common organisms involved are E coli,

Klebsiella species, and clostridial species

• Definitive treatment involves surgical intervention

• Preoperative percutaneous drainage may improve survival

Management

Surgical intervention1. Open

cholecystectomy• a major abdominal

surgery in which the surgeon removes the gallbladder through a 10 to 18 cm (4- to 7-inch) incision

Management

2. Laparoscopic cholecystectomy• requires several small incisions in the abdomen

to allow the insertion of operating ports, small cylindrical tubes approximately 5-10 mm in diameter, through which surgical instruments and a video camera are placed into the abdominal cavity

• The surgeon watches the monitor and performs the operation by manipulating the surgical instruments through the operating ports

Management

Laparoscopic Cholecystectomy