Management

1. Assess whether she is symptomatic
   • No biliary symptoms: no urgent treatment and no routine antibiotics. A 5 mm gallbladder stone alone is not an indication for surgery. Observation with safety-net advice is appropriate.
   • Biliary colic: episodic post-meal right-upper-quadrant or epigastric pain, often with nausea, but no fever or persistent tenderness. Refer for elective laparoscopic cholecystectomy, particularly if attacks recur or interfere with eating/function. Cholecystectomy is the standard definitive treatment for symptomatic stones. Bailey and Love's Short Practice of Surgery, p. 1266.
   • Postpartum status is not itself a contraindication to elective laparoscopic surgery. Pregnancy-associated biliary symptoms can recur after delivery, so a surgical review should not be indefinitely deferred. The SAGES biliary-disease guideline supports cholecystectomy for clinically significant biliary disease.
2. Check for ductal stone or another complication Obtain:
   • CBC
   • Liver panel: AST/ALT, alkaline phosphatase, GGT, total/direct bilirubin
   • Lipase if epigastric pain, vomiting, or pancreatitis is possible
   • Review ultrasound for common-bile-duct diameter and any reported duct stone.
   If jaundice, cholestatic liver tests, dilated common bile duct, or a duct stone is present: arrange urgent gastroenterology/surgical assessment with MRCP or EUS, with ERCP if choledocholithiasis is confirmed or strongly suspected. Ultrasound plus abnormal bilirubin/ALP should raise concern for biliary obstruction. Bailey and Love's Short Practice of Surgery, p. 1266.
3. Symptom control while awaiting review
   • Avoid large, high-fat meals if these reliably provoke pain.
   • Use hydration and simple analgesia such as acetaminophen or ibuprofen if there is no contraindication. Both are generally compatible with breastfeeding at usual doses, but prescribe based on her individual liver, renal, bleeding, allergy, and postpartum status.
   • Do not give antibiotics unless infection such as acute cholecystitis or cholangitis is suspected.
4. Manage hepatic steatosis separately “Hepatosteatosis” usually means fatty liver. It does not require gallbladder surgery by itself.
   • Review alcohol intake, body weight/waist, blood pressure, glucose or HbA1c, lipid profile, medications, and viral-hepatitis risk where indicated.
   • Repeat liver tests and arrange primary-care or hepatology follow-up if enzymes remain elevated.
   • Focus on gradual postpartum weight management, a Mediterranean-style eating pattern, physical activity, and avoidance of alcohol. Avoid rapid weight loss or crash diets, which can worsen gallstone symptoms.
   • If abnormal liver tests are marked, do not assume fatty liver is the only cause. Evaluate for obstruction, viral hepatitis, medication injury, and postpartum liver disorders as clinically indicated.

Seek emergency care now if any of the following occur

• Fever or chills
• Pain lasting more than 4-6 hours, escalating pain, guarding, or persistent vomiting
• Jaundice, dark urine, pale stools, or itching
• Hypotension, confusion, or severe weakness
• Severe epigastric pain radiating to the back, especially with vomiting, suggesting pancreatitis.