diapositivas de colangitis

8/15/2019 diapositivas de colangitis

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COLANGITI

AGUDAPRESENTADO POR:LILIAN NOEMI CALDERÓN MENAROTACIÓN: TRATAMIENTO PRE – TRANS – POSTQUIRURGICO

DOCENTE: DR. RICARDO GONZALES DURAND

UNIVERSIDAD NACIONAL DEL ALTIPLANOFACULTAD DE MEDICINA HUMANA

CATEDRA CIRUGIA - I


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GENERALIDA

ES


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DEFINICIÓN

CONDICION MORBIDA CON INFLAMACIÓN AGUDA de la !a "#l#a$ %a '(a INFECCIÓN BACTERIANA) a%*ada &*( '(a *"%+$'&&a"#+'ale(+e e&/(#&a del 0'1* "#l#a$

• F#e"$e I(+e$#+e(+&*( e%&al*2$!*%

• D*l*$ e(H#3*&*(d$#*de$e&*

• I&+e$#a

Pe(+ada deRe4(*ld%• H#3*+e(%#,(• Al+e$a*(e%

(e'$*l,5#&a%

T$#adade

Ca$&*+

6788:Ca$&*+

F#e"$eHe3/+#&

a

699:Re4(*l

d%

J Hepatobiliary Pancreat Surg (2007) ! "l#irante y $! Pigrau % &n'er# n'ecc icrobiol $lin! 2010*28(Supl


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FISIOPATOLOG


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FISIOPATOLOG;A

Re0'1* de l*% &a(ale% "#l#a$e%aa l*% %#('%*#de% e3/+#&*%< P$e%#,( "#l#a$ = > & de H>O.

L*% %!(+*a% %e de"e( al

$e0'1* e #(a%#,( "a&+e$#a(a del*% +e1#d*% 3e$#d'&+ale%) &*(#(0aa,(.

ZUIDEMA) GEORGE D. SHAC?ELFORD) CIRUG;A DEL APARATO DIGESTIVO. EDITORIAL M@DICA PANAMERICANA. A ED.

> FACTORES

AUMENTO BACTERIANO EN LOCONDUCTOS BILIARES

PRESION INTRADUCTAL ELEVA


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F#%#*3a+*l*5#a

I(2e&,("a&+e$#a(a de !a

"#l#a$O"%+$'&,( "#l#a$

Ba&+e$#"#l#a

P$e%#,( "#l#a$(*$al

Ve(a e3/+#&a 4l#(2a 3e$#

e3/+#&a

P$e%#,( "#l#a$A'e(+ada

E%+e$#l

M#&$**$5a(#%*%

7 – 14 cm H2O

Ca"#*% #(0aa+*$#*% dde l*% &*(d'&+*% #(+e+$ae3/+#&*%.

P'ede( *"%e$a$%e "a&+ele'&*+a$#* e( el #l#* e


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ETIOLOGIA


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E+#*l*5!aC*la(5#+#% 3$#a$#a

- C*led*&*l#+#a%#%- E%+e(*%#%

- Pa$a%#+*%#%- Q'#%+e% de&*led*&*

- E(2e$edad de

Ca$*l#- C*la(5#+#%e%&le$*%a(+e

- Ne*3la%#a%

C*la(5#+#%%e&'(da$#a%

- A&*(e%+e$a3e'+#&a% *

d#a5(*%+#&a%

M#&$**$5a(#%*%

- E. C*l#

- ?le"%#ella3(e'*(#ae- Ba&+e$*#de%2$a5#l#%- E(+e$*"a&+e$


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CUADRO

CLINICO


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T$#ada de

&a$&*+8

FIEBRE ALTA 9. ICTERICIA. 7

DOLOR ENHIPOCONDRIODERECHO 9

OBNUBILACION COMA

SHOC? SEPTICO IRA

Pe(+ada de

Re4(*ld

Cl#(#&a

a4*$e% de 8 a*%) d#a"J+#&*%)de"'+a( e( *&a%#*(e% %*l* &*(e"$e) %e3%#% #(e3l#&a"le *&*(2'%#,( e(+al.

C*la(5#+#% a5'da%#3le

C*la(5#+#% a5'daS'3'$ada


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DIAGNOSTIC


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D#a5(*%+#&*6. Cl#(#&a

>. La"*$a+*$#al-Le'&*+*%#% K de%#a*(#'#e$da 7- He*%+a%#a 4 &*a5'la*(al+e$ada-

B#l#$$'"#(a a% de >5dl 7- TGO) TGP) FA) GGT- He*&'l+#* K

.Ia5e(*l*5#a - E&*5$aa

- TAC-CPRE 4 CTPH


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Ta"le 6 TG6 d#a5(*%+#& &$#+e$#a 2*$ a&'+e &*la(5#+#%

A. S4%+e#& #(0aa+#*(A-6. Fee$ a(d*$ %a#(5 &#ll%A->. La"*$a+*$4 da+a: e#de(&e *2 #(0aa+*$4 $e%3*(%eB. C*le%+a%#%B-6. a'(d#&eB->. La"*$a+*$4 da+a: a"(*$al l#e$ 2'(&+#*( +e%+%C. Ia5#(5C-6. B#l#a$4 d#la+a+#*(

C->. E#de(&e *2 +e e+#*l*54 *( #a5#(5 %+$#&+'$e) %+*(e) %+e(+ e+&.S'%3e&+ed d#a5(*%#%: O(e #+e #( A *(e #+e #( e#+e$ B *$ CDe(#+e d#a5(*%#%: O(e #+e #( A) *(e #+e #( B a(d *(e #+e #( C


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• N*+e:

• A->: A"(*$al #+e "l**d &ell &*'(+%) #(&$ea%e *2 %e$' C-$ea&+#e 3$*+e#( leel%) a(d *+e$ &a(5e%#(0aa+#*(

• B->: I(&$ea%ed %e$' ALP) &GTP GGT) AST a(d ALT leel%.• O+e$ 2a&+*$% #& a$e el32'l #( d#a5(*%#% *2 a&'+e &*la(5#+#% #(&l'de a"d*#(al 3a#( $#5+ '33e$

'33e$ a"d*#(al a(d• a #%+*$4 *2 "#l#a$4 d#%ea%e %'& a% 5all%+*(e%) 3$e#*'% "#l#a$4 3$*&ed'$e%) a(d 3la&ee(+ *2 a "#l#a$4 • I( a&'+e e3a+#+#%) a$ed %4%+ea+#& #(0aa+*$4 $e%3*(%e #% *"%e$ed #(2$e'e(+l4. V#$*l*5#&al a(d

a$e $e'#$ed e(• d#e$e(+#al d#a5(*%#% #% d#&'l+.• T$e%*ld%• A-6 Fee$ BT7 C• A-> E#de(&e *2 #(0aa+*$4 $e%3*(%e BC 96lL WX) *$6 CRP 5dl C6• B-6 a'(d#&e T-B#l C> 5dL• B-> A"(*$al l#e$ 2'(&+#*( +e%+% ALP IU 6. 9 STD• &GTP IU 6. 9 STD• AST IU 6. 9 STD• ALT IU 6. 9 STD


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TRATAMIENT

Ha5a &l#& e( el #&*(* 3a$a a5$e5a$ '(a #a5e(


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Ha5a &l#& e( el #&*(* 3a$a a5$e5a$ '(a #a5e(


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SINDROME GILBERT Y CRIGLENAAR


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T$a+a#e(+*

6. S*3*$+e 5e(e$al: M*(#+*$#a*() Al+. HE) #d$a+a*(

>. T*a de e*&'l+#*%

. A(+#"#*+#&*% : 8 – 6 d#a%

ATB% D$e(a1e "#l#a$


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A(+#"#*+#&*%

A'%e(a dea(#3'la,(

M#&$**$5a(#%*%e(+e$#&*%

- a3#l#(a * a*#l#(a

&la'l/#&* 65$ -7 *- Ce2*+a#a 65$-7)&e2+$#a*(a 65$>X # *&e2+a#d#a 65$ # &*('( a#(*5l'&,%#d* 5e(+a#(a >X5$>X#)

I(%+$'e(+a,(

P%e'd**(a)a(ae$*"#*%

C $a G Ka#(*5l'&*%#d* K

Me+$*(#da*l 5&7


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X. D$e(a1e "#l#a$

&*le%+e&+*#a

C*led*&*+*#a

E+$a&,( de &/l&'l*%) laad*%) 4 d$e(a1e "#l#a$ +$a(&!%+#&*

e( T de ?e$ CTPH

CPRE

TTO '#$'$5&* de *+$a% &a'%a%:

- Pa$a%#+*%#%: '#%+*3e$#'#%+e&+*#a% +*+ale% * 3a$ale%- E%+e(*%#%: d#la+a*(e% * de$#a,( "#l#*d#5e%+#a.- Q'#%+e de &*lJd*&*: eJ$e%#% 4 de$#a*(e% "#l#*d#5e%+#a%.- E(2e$edad de Ca$*l#: %e5e(+e&+*#a%) l*"e&+*#a% 4 +$a%3la- C*la(5#+#% e%&le$*%a(+e: &*la(5#*4e4'(*%+*#a #(+$ae3/+#&a 4

+$a%3la(+e.- T'*$e% "#l#a$e% * 3a(&$e/+#&*%: $e%e&,() de$#a,( * d$e(a1e


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