1. Laboratory Studies Patients have leukocytosis that is markedly high sometimes Liver transaminases are typically normal or slightly elevated, reflecting the patient's febrile state Very abnormal liver test results (in particular, ALP, bilirubin, or GGTP) suggest a common duct obstruction or intrahepatic disease Urinalysis, chest radiograph, and electrocardiogram—obtained as part of the patient’s preoperative assessment

2. Imaging Studies Abdominal Radiograph gallbladder lumen/wall/perich olecystic tissues contains gas upright view of the abdomen demonstrates air- fluid levels in the gallbladder

3. Imaging Studies CT scan Air in the lumen of the gallbladder Thickened wall of the gallbladder

4. Management Medications are used to control infection and manage comorbidities – The 3 most common organisms involved are E coli, Klebsiella species, and clostridial species Definitive treatment involves surgical intervention Preoperative percutaneous drainage may improve survival

5. Management Surgical intervention 1. Open cholecystectomy a major abdominal surgery in which the surgeon removes the gallbladder through a 10 to 18 cm (4- to 7-inch) incision

6. Management 2. Laparoscopic cholecystectomy requires several small incisions in the abdomen to allow the insertion of operating ports, small cylindrical tubes approximately 5-10 mm in diameter, through which surgical instruments and a video camera are placed into the abdominal cavity The surgeon watches the monitor and performs the operation by manipulating the surgical instruments through the operating ports

7. Management Laparoscopic Cholecystectomy