Cholecystitis Dan Gallstone

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    GALL STONEDAN KOMPLIKASINYA

     Nyoman Purwadi

    Divisi Gastro Hepatoo!i

    "a!#$SM% Penya&it Daam

    %K 'nud$ (S San!a)

    Denpasar 

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    *ESI+LE +OMPOSITION

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    GALL STONE

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    Harvest Time

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     A,ute and +)roni, +)oe,ystitis and +)oeit)iasis

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      Pat)o!enesis pi!ment stone

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    (ISK %A+TO(S

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    +LINI+AL MANI%ESTATION

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    KOLESISTITIS AKUT

    Adalah reaksi inflamasi akut dindingkandung empedu dgn ditandai adanya:

    = yeri perut kanan atas

    = !anas "adan

    #akt$r yg "erperan :

    = stasis %airan

    = infeksi kuman

    = iskemia dinding

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    !E&'A(IA

    "erdasar penye-a- di-a!i ./0 Koesistitis a&ut &a&uus / 12345 ter6adi

    &arena ada -atu y! menyum-at du,tus

    ,ysti,us0 Koesistitis a&ut a&a&uus / didapat pd

     pasien y! dirawat ,u&up ama dan d!n

    nutrisi parentera7 &e!anasan G"7 atau

    merupa&an &ompi&asi demam ti8oid

    atan

    DM

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    (E)ALA KLIIS

    Keluhan yg khas adalah := K$lik perut kanan atas

    = yeri tekan perut kanan atas

    = kenaikan temperatur= *asa sakit men+alar ke pundak atau

    s%apula kanan

    Keluhan "ervariasi mulai dari keluhan

    ringan

    Sam ai keluhan "erat se erti erf$rasi

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    !d pemeriksaan fisis :

    = yeri tekan perut kanan atas= ,emam

    = &urphy sign

    La"$rat$rium :

    = lek$sit$sis

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    &U*!H- SI(9 Pasien terentan! dan pemeri&sa ada di sisi

    &anan penderita

    9 Dia&u&an pene&anan den!an tan!an &anan

    di perut &anan atas7 ta)an pada posisi ini7 dan

     pasien diminta menari& na8as daam / na8as

    ter)enti &rn pasien &esa&itan7 Murp)y si!n positi8 

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    ,IA(OSIS

    9 !LAI #OTO A',O&E

    9 KOLESISTO(*A#I

    9 US(

    9 SKITI(*A#I

    9 .T/ S.A

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    PAIN PHOTO A"DOMEN

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    'LT(ASONOG(APHY

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    !E(O'ATA

    = 'edrest

    = utrisi parenteral= !ain killer

    = Anti"i$tik sistemik = K$lesistekt$mi  

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    ACUTE CHOLANGITISACUTE CHOLANGITIS

    Inflammatory

    processinvolving the

    bile !cts that

    !s!ally res!lts

    from biliaryobstr!ction

    an associate

    biliary

    infection an

    can be life

    threatening

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    "ATHO"H#SIOLOG#"ATHO"H#SIOLOG#

    Sterile bile in healthyinivi!als

    $iliary tractcompromise

    %e&g& stone' strict!re'enoprosthesis(

    $acteria in the bile

    Obstr!ction

    $iliary press!re rises

    $acteria ) pro!cts

    %e&g&enoto*in( in the

    bile systemic

    circ!lation

    Enoto*aemia )

    septicaemiaVan Lent AUG et al. Gastrointest Endosc 2002;55:518-22; Lee DWH, !"n# $$. %ailliere&s lin Gastroenterol

    1''(;11)*+.

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    AETIOLOG#AETIOLOG#

    Obstr!ction Can Ca!se by+

     Stone %the most common(

     $enign strict!res

     Neoplasm

     ,irect cholangiography

     Sclerosing cholangitis

     -oreign boies

    Lee DWH, !"n# $$. %ailliere&s lin Gastroenterol 1''(;11)*+.

    C C S

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    CLINICAL -EATU.ESCLINICAL -EATU.ES CHA.COT/S T.IA,

     Abominal %right !pper 0!arant( pain  -ever 

      1a!nice

    .E#NOL,/S "ENTA,  Charcot/s tria 2  3ental conf!sion

      Hypotension Severe cholangitis

    Other symptoms Chills

    .igors Tea4colo!re !rine "r!rit!s "ale stools

     Lee DWH, !"n# $$. %ailliere&s lin Gastroenterol 1''(;11)*+.

    G OS S,IAGNOSIS

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    ,IAGNOSIS,IAGNOSIS

      History %Charcot/s Tria(

      Complete "hysical -inings

    Charcot/s Tria

    .eynol/s "enta  Laboratory E*amination

      "lain -oto Abomen

      Ultraso!n E*amination  CT Scan

      "TC an E.C"

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    3ANAGE3ENT3ANAGE3ENT I5 fl!is an I5 antibiotics 2 monitoring bloo

    press!re' p!lse' an !rinary o!tp!t

    Antibiotic therapy

      678 of patients 9ill respon to I5 antibiotics

      3ortality of ac!te cholangitis has ecrease from:;;8 to

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     Ac"te ancreatitis

    Etiolo#ies /dioat!ic

    Gallstones )or ot!er

    ostr"ctie lesions+ EtH

    3ra"4a

    $teroids

    "4s )6 ot!erir"ses: V, E%V+

     A"toi44"ne )$LE,ol7arteritis nodosa+

    $corion stin#

    H7er a, 3G

    E9 )5-10 o ts

    "nder#oin# roced"re+ Dr"#s )t!ia

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    $i#ns 6 $74to4s

    $eere ei#astric ado4inal ain - ar"t onset)4a7 radiate to ac>+

    =a"sea 6 Vo4itin#

    Wea>ness 3ac!7cardia ?@- eer; ?@- H7otension or s!oc>

    Gre7 3"rner si#n - lan> discoloration d"e toretroeritoneal leed in t. Bit! ancreatic necrosis)rare+

    "llen&s si#n - eri"4ilical discoloration )rare+

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    Gre7 3"rner si#n "llen&s si#n

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    Eal"ation

      amylaseC=onseciic  A47lase leels F nor4al er7 s"##estie o

    ancreatitis

    a7 e nor4al in c!ronic ancreatitis En

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    adio#ra!ic Eal"ation

    9lain oto - sentinel looI or s4all oBel ile"s U$ or 3 4a7 s!oB enlar#ed ancreas Bit!

    strandin#, ascess, l"id collections, !e4orr!a#e,

    necrosis or se"doc7st /@9 neBest adI

    Decreased ne!rotoicit7 ro4 #adolini"4

    %etter is"ali

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    3 $can o ac"te ancreatitis

    3 s!oBs

    si#niicant

    sBellin#and

    inla44ation

    o t!e

    ancreas

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    Gall stone ancreatitis 7 E9

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    3!era7

    e4oe oendin# a#ent )i ossile+

    $"ortie

    J1- =9 )"ntil ain ree+ =G s"ction or atients Bit! ile"s or e4esis

    39= 4a7 e needed

    J2- A##ressie ol"4e reletion Bit! /V Kee an e7e on l"id alance@se"estration

    and electrol7te dist"rances

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    3!era7 contin"ed

    JF- =arcotic anal#esics "s"all7 necessar7 or ainrelieCtetoo>s sa7 eeridineC

    NO concl"sie eidence t!at 4or!ine !as

    deleterio"s eect on s!incter o ddi ress"re J*- Ur#ent E9 and iliar7 s!incteroto47 Bit!in

    (2 !o"rs i4roes o"tco4e o seere #allstoneancreatitis

    ed"ced iliar7 sesis, not act"al i4roe4ent oancreatic inla44ation

    J5- Don&t or#et 99/ to reent stress "lcer 

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    TE*I&A KASIH