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General Surgery


Answer 1
  1. Unless she has cholecystitis, cholelithiasis with symptomatic biliary colic is unlikely. Symptomatic and asymptomatic cholelithiasis commonly occur in the absence of cholecystitis, an infection of the gallbladder. Cholecystitis can develop from bacteria alone or as a consequence of cystic duct obstruction by a stone. Hispanic women have a high prevalence of biliary disease, including cholelithiasis, which often occurs during and after pregnancy. The laparoscopic approach has become the standard technique for cholecystectomy. The frequency of common bile duct injury is reported to range from 1.0% to 1.5%, or approximately twice that of the open procedure. The reported need to convert to an open cholecystectomy is 5%; to proceed safely, the surgeon should not hesitate to convert to an open technique. The patient is unlikely to have a bile duct obstruction, given her normal serum bilirubin and alkaline phosphatase levels. The elevated serum amylase level suggests that she has experienced biliary colic while passing a stone that resulted in mild pancreatitis.

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