NMS. Casos Clínicos

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Chapter 7 ♦ Pancreatic and Hepatic Disorders

Q: How would you establish the diagnosis? A: The most efficient method of diagnosis is an ultrasound of the RUQ. Findings on ultra- sound suggestive of gallbladder disease include thickening of the gallbladder wall, pericho- lecystic fluid, and the presence of gallstones (Fig. 7-2). Q: What blood chemistries would you expect to be abnormal with a diagnosis of cholelithiasis? A: Blood tests should include a complete blood count (CBC) with differential, amylase, lipase, and liver function tests. Mild leukocytosis is present in some patients; a white blood count

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B Figure 7-2: Acute cholecystitis. A. Gallbladder ultrasound. The presence of gallstones, thickening of the gallbladder wall, and gallbladder wall edema are suggestive of acute cholecystitis. (From Hughes SJ. Operative Techniques in Hepato-Pancreato-Biliary Surgery . Wolters Kluwer Health; 2015, Fig. 2.1B.) B. Computed tomography scan of a patient with acute cholecystitis. The gallbladder contains multiple gallstones, has a thick wall, and is surrounded by stranding and edema. (From Lawrence PF. Essentials of General Surgery and Surgical Specialties , 6th ed. Wolters Kluwer Health; 2018, Fig. 16-4.) SAMPLE