A 40-year-old obese female presents to the emergency room complaining

A 40-year-old obese female presents to the emergency room complaining of severe RUQ abdominal pain, nausea, vomiting, and feeling feverish. On physical examination, the patient is noted to be tachycardic, diaphoretic, and has a temperature of 101 F. On abdominal palpation, the patient is noted to have severe subjective and objective tenderness to the RUQ with observable guarding and rebound. The patient’s lab work is suggestive of a leukocytosis and she is noted to have elevated AST/ALT levels. Ultrasound results are significant for cholelithiasis with cholecystitis. Upon consult with general surgery, the patient is recommended for surgery. As lead surgeon for this laparoscopic cholecystectomy, you note severe bleeding, but you are able to quickly arrest the blood flow by treating the bleeding vessels with electrocautery. Questions: 1. What structures must be ligated and severed in a cholecystectomy? 2. What landmarks are used to locate and identify these structures? 3. What risk factors may have contributed to the patient’s diagnosis? 4. What would the patient be at risk for if she had not had the surgery? 5. What structures would be involved in follow-up to question #4?

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