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8/18/2019 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