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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