cholecystitis

[size=20px]A 13-year old girl presents with mild epigastric pain. Laboratory studies include an AST 135 IU/L, ALT 173 IU/L, total bilirubin 1.9 mg/dL, direct bilirubin 1.4 mg/dL, amylase of 400 u/L, lipase of 500 u/L. Right upper quadrant ultrasound shows small stones in the gallbladder with a 7-mm diameter common bile duct, but no stone was noted in the common duct. The following day, direct bilirubin is 0.7 mg/dL, amylase is 100 u/L, and lipase is 75u/L. The best next step in this child’s management is a MRCP b IV antibiotics c Laparoscopic cholecystectomy with IOC when amylase and lipase normalize d ERCP e Laparoscopic cholecystectomy with intraoperative…

[size=20px]A 12-year-old patient undergoes laparoscopic cholecystectomy for acute cholecystitis and choledocholithiasis. She returns on POD 2 with abdominal pain and fevers. Ultrasound shows a large fluid collection in the right upper quadrant. ERCP shows extravasation of bile from the cystic duct. A biliary stent was placed. Two days later, her symptoms resolved and she went home. The stent was removed 8 weeks later. She had no long term problems. This patient’s complication can be classified as Clavien Dindo a 1 b 2 c 3A d 3B e 4A[/size]

[size=20px]A 14-year old girl presents with mild epigastric pain. Laboratory studies include an AST 125 IU/L, ALT 180 IU/L, total bilirubin 1.8 mg/dL, direct bilirubin 1.2 mg/dL, amylase of 400 u/L, lipase of 500 u/L. Right upper quadrant ultrasound shows small stones in the gallbladder with a 7-mm diameter common bile duct, but no stone was noted in the common duct. The following day, direct bilirubin is 0.7 mg/dL, amylase is 100 u/L, and lipase is 75u/L. The best next step in this child’s management is a ERCP b IV antibiotics c Laparoscopic cholecystectomy with IOC when amylase and lipase normalize d Laparoscopic cholecystectomy with intraoperative cholangio…

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Quote from "ESPES Manual of Pediatric Minimally Invasive Surgery" by Ciro Esposito, François Becmeur, Henri Steyaert, Philipp Szavay - "The first ever cholecystectomy on record was performed on July 15, 1882, by Carl Johann August Langenbuch (1846–1901) at Lazarus Krankenhaus in Berlin [1]. Few years earlier, on July 15, 1867, John Stough Bobbs of Indianapolis had performed a cholecystostomy on a 30-year-old woman with ovarian cancer [2]. It was over 100 years later, in Germany again, that Erich Mühe of Boblingen performed the first laparoscopic (Fig. 37.1) cholecystectomy [3]. This was a turning point for minimal access approach in general surgery. Another major advan…

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[size=20px]A 7 year-old girl with sickle cell disease presents to the emergency department with 3 days of right upper quadrant pain. Laboratory investigations are significant for a total bilirubin of 2.9 mg/dL and direct bilirubin of 2.5 mg/dL. Lipase and liver enzymes are normal. Abdominal ultrasound is significant for cholelithiasis and pericholecystic fluid. The CBD is within normal limits and there is no intrahepatic duct dilatation. What is the best next step in the management of this patient? A Laparoscopic cholecystectomy only B Laparoscopic cholecystectomy with post-operative bilirubin trend C MRCP followed by laparoscopic cholecystectomy D Laparoscopi…

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