digest ipan f.h (08711026)
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Humongous Insurance
COLELITHIASIS
Presented by Ipan Ferrel Heady08711026
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COLELITHIASIS
• Adalah suatu matrial yang mirip batu pada kandung empedu dan saluran empedu
• Wanita > pria• 4F Femle, Fertil, Fat, Forty• Batu terdiri dari cholesterol, calcium
bilirubinate dan calcium carbonate atau campuran ketiganya
• genetik
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Batu kolesterol• Empedu harus mengalami
supersaturasi oleh kolesterol didalam kandung empedu.
• Pembentukan inti batu empedu (nukleasi) dimungkinkan secara kinetis ( terjadi percepatan kristalisasi kolesterol).
• Kristal kolesterol yang terbentuk harus berada cukup lama di kandung empedu
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Batu pigmen
1. Batu coklat : infeksi (E.coly) enzim β-glucuronidase mengubah bilirubin tak terkonjugasi mengendap berikatan Ca2+calsium bilirubinat
Lokasi :1. pada kandung empedu 2. duktus koledokus / saluran
empedu 3. duktus sistikus
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Manifestasi klinis• Nyeri di kuadran kanan atas,sering
menjalar ke inter-scapula
• Mual muntah,demam + menggigigl (komplikasi)
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PemeriksaanAnamnesis : keluhan nyeri kanan
atas,menjalar,lebih dari 15 menit,setelah makan atau menarik nafas, dan nyeri saat tersentuh.Terdapat mual muntah.
Fisik :Murphy’s sign positif
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Penujang
• Laboratorium : Leucocytosis, serum bilirubin meningkat 1-4 mg/ml
• Pencitraan : 1. Ultrasonografi (USG)2.Endoscopic ultrasonografi
(EUS)3. Magnetic Resonance
Cholangio- pancreatography (MRCP)
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Penatalaksanaan
• Non operatif1. Asam ursodeoksilat (obat pelarut
batu empedu) botu < 1cm 8 tablet perhari selama 2 bulan atau lebih.
2. Extracorporeal Short Wave Lithotryptor ( ESWL ) batu < 3cm
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........
• Operatif• a). Open kolesistektomi • b). Kolesistektomi laparoskopik
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Questions and no answers
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