A 36-year-old woman is admitted to a the hospital with upper abdominal pain, hyperamylasemia, elevation of serum alkaline phosphatase and ultrasound evidence of cholelithiasis. With intravenous hydration and analgesia, symptoms rapidly resolved. After 48 hours, serum amylase and alkaline phosphatase values had returned to normal and physical examination revealed lessening tenderness in the right upper quadrant of the abdomen. Appropriate management consists of which of the following as the next step?
A. Cholecystectomy and intraoperative cholangiography before hospital discharge
B. Elective cholecystectomy at approximately 8 weeks
C. Endoscopic sphincterotomy before discharge followed by cholecystectomy at approximately 8 weeks
D. Observation
Answer:A
A 36-year-old woman is admitted to a the hospital with upper abdominal pain, hyperamylasemia, elevation of serum alkaline phosphatase and ultrasound evidence of cholelithiasis. With intravenous hydration and analgesia, symptoms rapidly resolved. After 48 hours, serum amylase and alkaline phosphatase values had returned to normal and physical examination revealed lessening tenderness in the right upper quadrant of the abdomen. Appropriate management consists of which of the following as the next step?
A. Cholecystectomy and intraoperative cholangiography before hospital discharge B. Elective cholecystectomy at approximately 8 weeks C. Endoscopic sphincterotomy before discharge followed by cholecystectomy at approximately 8 weeks D. Observation