Benign Postoperative cholestasis
Features	Post prolonged surgery
S/S	Asx
Dx	US
Tx	Nothing. This will go with time.

Tx of Gallstones
w/o sx	·       No treatment necessary in most patients
w/ typical biliary colic sx	·       Elective laparoscopic cholecystectomy ·       Possible ursodeoxycholic acid in poor surgical candidates
Complicated gallstones disease (acute cholecystitis, choledocholithiasis, gallstone pancreatitis)	·       Cholecystectomy within 72 hours

	Emphysematous cholecystitis
RF	·       DM ·       Vascular compromise ·       Immunosuppression
Clx	·       Fever, RUQ pain, N/V ·       Crepitus in abdominal wall adjacent to gallbladder
Dx	·       Air-fluid levels in gallbladder, gas in gallbladder wall ·       Cx with gas-forming Clostridium, Escherichia coli ·       Unconjugated hyperbilirubinemia ·       Mildly elevated aminotransferases
Tx	·       Emergency cholecystectomy ·       Broad-spectrum ABx with Clostridium coverage (e.g., piperacillin-tazobactam)

	Acute cholangitis
Clx	·       ∆ fever, jaundice, RUQ pain
Dx	·       LFT o   ↑ direct bilirubin and ALP o   Mildly ↑ aminotransferases ·       Biliary dilation on US/CT
Tx	1˚ Abx coverage of enteric bacteria 2˚ ERCP within 24-48 hours