ASKEP KLIEN DG CHOLELITHIASIS

Nursiswati

 Cholelithiasis, is a relatively common disease, over 10% of the adult population of European countries have this disease. In most cases, cholelithiasis is discovered during a routine abdominal ultrasound, but also can give symptoms.

The main causes incriminated in the development of cholelithiasis are:

Genetic predisposition; Female gender: the ratio women / men being 2-3/1; Obesity; Age; Dyslipidaemia; Diabetes; Hypertriglyceridaemia.

Pathogenesis
Cholelithiasis, occurs as a consequence of breaking the existing balance in the bile, where cholesterol, bile acids and lecithin are in a balance that ensures cholesterol solubilisation. An increase in the elimination of cholesterol (in dyslipidemia, the sudden loss weight, diabetes, obesity) or on the contrary, a decrease in bile acid secretion will lead to breaking the balance that ensures cholesterol solubilisation at its precipitation in the gallbladder, with cholesterol crystals development. Biliary stasis is another factor that favors the appearance of gallstones.

Classification of cholelithiasis:
A modern concept of cholelithiasis is the classification in: Symptomatic cholelithiasis, it is the one that generates biliary colic. Biliary colic represents a intense or violent pain in the epigastrium or right hypochondrium , lasting about 30 minutes. Nausea, vomiting and headache, occurring in outside of biliary colic, dose not represent symptomatic cholelithiasis. Asymptomatic cholelithiasis is the form of the disease that does not cause biliary colic.

Complications of cholelithiasis
Biliary colic; Acute cholecystitis; Migration of gallbladder stones in coledoc; Vesicular hydrops; Acute pancreatitis; Gallbladder cancer.

TREATMENT
Non-surgical treatment techniques of cholelithiasis are drug litholysis and shock wave lithopripsy, less used lately due to the high degree of occurrence of the relapse. Drug litholysis is addressed to cholesterol gallstones, preferably small. Treatment consists of administration of ursodeoxycholic acid or combined with chenodeoxycholic acid, for a period of 3 to 12 months, until the complete dissolution of gallstones apper. Chance of success is about 50% and the risk of relapse within 5 years is 10%. Supervision is done by abdominal ultrasound. Shock Wave Lithotripsy, consists in bombing of cholesterol stones with shock waves. It is addressed to unique gallstones or less numerous stones, preferably less than 15 mm. Fragments will be dissolved by the administration of bile acids (ursodeoxycholic acid), up to complete disappearance of all fragments of stones from the gallbladder.

The prognosis of cholelithiasis:

Cholelithiasis has often a good prognosis because symptomatic cases are most often solved by surgery and the asymptomatic forms are kept under surveillance.

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