14 cholelithiasis.ppt
TRANSCRIPT
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CHOLELITHIASIS
Dr.Suryadi Soedarmo,SpB
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Chole – empeduLithiasis - batu
Cholecysto – gallbladderCholedocho – d.choledochus
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ANATOMI SISTEM BILIARIS
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FISIOLOGI SISTEM BILIARIS
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MetabolikMetabolik
Batu
Stasis Infeksi
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TIPE BATUBatu kolesterol (80%)
bentuk oval, multifokalmengandung >70% kolesterol
Batu kalsium bilirubinat (20%)warna coklat atau coklat tua lunak, mudah dihancurkankomponen utama: kalsium bilirubinat
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PATOGENESIS BATU EMPEDU
Batu kolesterol (proses metabolik)supersaturasi kolesterolpembentukan niduskristalisasipertumbuhan batu
Radio-luscent 4 F : = Fat = (over) Forty = Fertilized = Female
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Batu kalsium bilirubinatfaktor stasisinfeksi saluran empedu oleh E.coli
Radio-opaque
Metabolik
Batu
Stasis Infeksi
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MANIFESTASI KLINIS cholelithiasis
1. Asimtomatik
2. Kolik bilier
3. Kolesistitis akut
4. Pankreatitis batu
empedu
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Batu empedu asimtomatik
<25% pasien membutuhkan intervensi dalam periode waktu 5 tahun
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BiliaryColic
Metabolik
Batu
Stasis Infeksi
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PEMERIKSAAN PENUNJANG
Foto polos abdomen Kolesistografi USG ERCP MRCP PTC
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Foto Polos Abdomen
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Oral cholecystography
-Biloptin tab.- Fungsi ekskresi hepar baik Bil < 4 mg%- Jarang dilakukan
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USG
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ERCP
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ERCP(Endoscopic Retrograde
Cholangiopancreatography)
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ERCP
Kalau terlihat batu diambil
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ERCP
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ERCP
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PTC(Percutaneus Transhepatic
Cholangiography)
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MRCP (Magnetic Resonance
Cholangiopancreatography)
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MRCP
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MRCP
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Terapi cholelithiasis
Obat-batan
Urso-deoxycholic acid ESWL : baik hasil di urolithiasis
buruk di cholelithiasis Operative
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Manifestasi Cholelithiasis
1. Cholecystitis
2. Choledocholithias
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Kolesistitis akut
Manifestasi bilier paling sering Biasanya calculous cholecystitis Respon peradangan:
distensi edema hipervaskularisasi
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Kolesistitis akut
Respon peradangan dicetuskan 3 faktor:
- inflamasi mekanik
Tekanan intra lumendistensiiskemi mukosa & dinding kandung
empedu
- inflamasi kimiawi
Pelepasan lesitin & faktor jaringan lokal
- inflamasi bakteri
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Kolesistitis akut
Nyeri perut kanan atasmenjalar ke scapula kananmenetap > 4-6 jam
Kolik bilier (batu?)Nausea & vomitusIkterus ringanPeritonitis lokal & Murphy sign (+)
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Kolik bilier
Spasme tonik Nyeri RUQ 30-60 menit pascaprandial Dipresipitasi oleh makanan berlemak Berakhir setelah beberapa jam lalu pulih Menjalar ke abdomen kanan,pundak, punggung,
abdomen kiri Dapat menyerupai angina pektoris Mual dan muntah
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Kolesistitis akut
Laboratorium:
leukositosis
bilirubin ± 2-3 mg/dl
amilase ≥ 1000 U/dl
transaminase & fosfatase alkali ↑
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Kolesistitis akut
Pemeriksaan penunjang:
Foto polos abdomen
USG
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Kolesistitis akut
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Kolesistitis akut
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Kolesistitis akut
Diagnosis banding:
pankreatitis akut, tukak peptik,
apendisitis akut, atau abses hati
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Terapi : open cholecystectomy
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Lasparoscopic Cholecystectomy
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Lasparoscopic Cholecystectomy
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Koledokolitiasis
Batu dalam duktus koledokus Manifestasi klinis:
asimtomatis
kolik
jaundice
demam & menggigil
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Koledokolitiasis
Pemeriksaan penunjang:Laboratorium
leukositosis
bilirubin ↑ dlm 24 jam
alkali fosfatase ↑ dan ↓ dalam 1-2 mgg
serum amilase ↑ ≤ 1000 U
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Koledokolitiasis
Pemeriksaan penunjang:
• USG
• (Kolesistografi)
• CT Scan
• ERCP
• PTC
• MRCP
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Koledokolitiasis
Terapi : choledocholithomy
Biasanya didahului cholecystectomyD.Choledochus dibuka (choledochotomy)Lalu ekstraksi batuKalau batu >> flushing
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Koledokolitiasis
Terapi : choledocholithomy
T-Tube
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Koledokolitiasis
Sebelum T-Tube
dilepas dilakukan
T-tube cholangio-
graphy
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Koledokolitiasis
Cholecystostomy :-jarang- Hanya kalau KU buruk
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PANKREATITIS BATU EMPEDU
diakibatkan obstruksi ampula Vateri oleh batu empedu pankreatitis
Nyeri perut timbul tiba-tiba perlahan di pertengahan epigastrium menjalar menembus ke belakang. Berkurang bila duduk membungkuk dan bertambah bila terlentang. Muntah tanpa mual terjadi waktu lanbung sudah kosong
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Pemeriksaan fisik:perut tegang dan demam, takikardia dan leukositosisRangsangan cairan pankreas dapat
menyebar ke perut bawah atau ke rongga dada kiri efusi pleura kiri
Umumnya tampak tanda ileus paralitik
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TERIMA KASIH