Cholecystitis & Pregnancy - KSherafgan-1

Cholecystitis & Pregnancy - KSherafgan-1 -...

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Cholecystitis & Pregnancy Kashaf Sherafgan, MD PGY-2, General Surgery Englewood Hospital December 21 st 2005
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Case Presentation 23-year-old woman, 16 weeks pregnant c/o abd pain x 2 days RUQ pain, radiating to back Similar complaint X 3 over 2 months Last ER presentation 2 days ago
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Physical examination Afebrile Minimal scleral icterus Epigastric tenderness Positive Murphy’s sign Gravid uterus
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Laboratory workup WBC: 7400 (78.2% neutrophils) AST / ALT: 103 / 200 Alk Phos: 128 T / D Bili: 3.5 / 1.9 Amylase: 108 Lipase: 106 UA: Moderate bilirubin
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Ultrasound Small shadowing gallstone within GB No wall thickening No pericholecystic fluid No biliary dilatation CBD ~ 5 mm
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Ultrasound
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Clinical course NPO IV hydration Pain control
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Hospital course, cont. Day 2 AST / ALT: 68 / 154 Alk Phos: 98 T/D Bili: 2.1 / 1.8 Amylase: 117 Lipase: 135
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MRCP Multiple gallstones No evidence of biliary duct dilatation CBD ~ 5 mm No evidence of CBD stones or intraluminal filling defects
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Hospital course, cont. Day 5 Pain on PO intake Increasing scleral icterus AST / ALT: 60 / 146 Alk Phos: 102 T/D Bili: 4.2 / 2.1 Amylase: 149 Lipase: 368
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Hospital course, cont: Day 7 Laparoscopic cholecystectomy Findings Minimal adhesions Distended thin-walled GB Thick sludge
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Post-operative course Immediately post op: AST / ALT: 56 / 137 Alk Phos: 134 T/D Bili: 3.0 / 2.0 Amylase / Lipase: 1.3 / 127
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Post-op course, cont. POD #2 AST / ALT: 36 / 97 Alk Phos: 117 T/D Bili: 1.8 / 1.4 Discharged home in stable condition
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Medical versus surgical management of biliary tract disease in pregnancy Lu EJ et al American J of Surg 2004;188:755
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Methods Retrospective multicenter study Compared maternal and fetal outcomes of medical vs surgical management Impact of complications of gallstone disease, including gallstone pancreatitis and choledocholithiasis, on fetal outcome
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Results 76 women with 78 pregnancies were admitted with biliary tract disease 63 presented with symptomatic cholelithiasis, 10 underwent surgery while pregnant No deaths, preterm deliveries, or ICU admissions 53 treated medically Courses complicated by symptomatic relapse in 20
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Cholecystitis & Pregnancy - KSherafgan-1 -...

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