Which of the following physiologic changes occurs as a result of carbon dioxide pneumoperitoneum?A Decreased pulmonary compliance due to diaphragm elevation and increased abdominal pressureB Metabolic alkalosis from systemic absorption of carbon dioxideC Increased cardiac output as a result of increased venous returnD Decreased systemic vascular resistanceE Decreased mean arterial pressure

31. The answer is A Physiologic changes associated with carbon dioxide pneumoperitoneum are complex and interdependent, but several generalizations can be made. Pulmonary compliance is decreased from diaphragmatic elevation and increased intra-abdominal pressure. Hypercarbia causes acidosis, not alkalosis. Cardiac output is usually decreased due to decreased venous return, and blood pressure and systemic vascular resistance are increased

32. A 32-year-old woman undergoes a laparoscopic cholecystectomy for biliary colic. Forty-eight hours after the operation, she complains of fever and right upper quadrant pain. Laboratory studies reveal an elevated white blood cell count as well as an elevated total bilirubin. Which of the following is not part of the initial management?A CT scan of the abdomenB Hydroxy iminodiacetic acid (HIDA) biliary scanC Surgical explorationD Endoscopic retrograde cholangiopancreatography (ERCP)E Broad spectrum antibiotics

32. The answer is C Bile duct injuries or bile leaks after laparoscopic cholecystectomy should not initially be managed by surgical exploration. Resuscitation, antibiotics, and appropriate imaging to define the anatomy of the problem are the first steps.

Disadvantages of laparoscopy when compared with laparotomy include all of the following except which?A Difficulty controlling severe bleedingB Poorer visualization of the operative fieldC Greater difficulty placing suturesD Loss of tactile sensationE Higher operating room costs

The answer is B (Chapter 30, II C). It is generally agreed that improved visualization of the operative field due to magnification and improved light delivery to remote areas of the abdomen are an advantage of laparoscopy over laparotomy. Difficulty controlling severe bleeding, greater difficulty placing sutures, loss of tactile sensation, and higher operating costs are clear disadvantages of laparoscopy as compared with laparotomy

Laparoscopic cholecystectomy is indicated for all of the following conditions except which?A Biliary dyskinesiaB Initial treatment in patients with severe cholangitisC Acute cholecystitisD Symptomatic cholelithiasisE Biliary pancreatitis

The answer is B Laparoscopic cholecystectomy is indicated for most symptomatic biliary conditions, including biliary colic, acute cholecystitis, biliary dyskinesia, and biliary pancreatitis, after resolution of pancreatitis. However, initial therapy for cholangitis is hydration, broad spectrum antibiotics, and drainage of the common bile duct. Cholecystectomy is performed at a later time, after resolution of sepsis.