NMS. Casos Clínicos

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Chapter 7 ♦ Pancreatic and Hepatic Disorders

cholecystectomy compared to open cholecystectomy. Injury to the hepatic artery is also a serious concern that may lead to hepatic ischemic injury or bile duct ischemia and stricture. Figure 7-3: Intraoperative cholangiogram showing a normal common duct and filling of the biliary tree. gb, gallbladder; c, common bile duct; arrow , junction of cystic duct with common bile duct. (From Yamada T, Alpers DH, Owyang C, et al. Textbook of Gastroenterology , 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 1999:2721.) SAMPLE You perform a laparoscopic cholecystectomy. Q: What is your postoperative management plan? A: Observe the patient for recovery from general anesthesia. Within 2–24 hours, most patients are ready for discharge, and they can be seen in the office in 7–10 days. Case 7.3 Right Upper Quadrant Pain with Gallstones and Signs of Infection You see a 30-year-old woman in the emergency department with RUQ pain, nau- sea, vomiting, and a temperature of 102°F. An ultrasound study reveals gallstones and a thickened, edematous gallbladder wall. Blood work indicates a WBC count of 19,000/mm 3 and an elevated alkaline phosphatase; the remaining studies are normal.