Harvest Time

Acute and Chronic Cholecystitis and Cholelithiasis

CLINICAL MANIFESTATION

KOLESISTITIS AKUT
Adalah reaksi inflamasi akut dinding kandung empedu dgn ditandai adanya: = Nyeri perut kanan atas = Panas badan Faktor yg berperan : = stasis cairan = infeksi kuman = iskemia dinding

PEMBAGIAN
Berdasar penyebab dibagi 2: = Kolesistitis akut kalkulus : (90%) terjadi karena ada batu yg menyumbat ductus cysticus = Kolesistitis akut akalkulus : didapat pd pasien yg dirawat cukup lama dan dgn nutrisi parenteral, keganasan GB, atau merupakan komplikasi demam tifoid atan DM

Acute calculous cholecystitis

Persistent cystic duct obstruction leads to GB distension, wall inflammation & edema Can lead to: empyema, gangrene, rupture Pain persists >24hrs with fever Palpable/tender or even visible RUQ mass Sg: Cholecystectomy within 48hrs

Chronic calculous cholecystitis

Recurrent inflammatory process due to recurrent cystic duct obstruction, 90% of the time due to gallstones Overtime, leads to scarring/wall thickening
Treatment: laparoscopic cholecystectomy

Acute acalculous cholecystitis

In 5-10% of cases of acute cholecystitis Seen in critically ill pts or prolonged TPN More likely to progress to gangrene, empyema, perforation due to ischemia Caused by gallbladder stasis from lack of enteral stimulation by cholecystokinin Tx: Emergent cholecystectomy

GEJALA KLINIS
Keluhan dan tanda yg khas adalah : = Kolik perut kanan atas = Nyeri tekan perut kanan atas = kenaikan temperatur = Rasa sakit menjalar ke pundak atau scapula kanan = Murphy sign positif

MURPHY SIGN
Pasien terlentang dan pemeriksa ada di sisi kanan penderita Dilakukan penekanan dengan tangan kanan di perut kanan atas, tahan pada posisi ini, dan pasien diminta menarik nafas dalam : nafas terhenti krn pasien kesakitan, Murphy sign positif

Diagnosis
History Physical exam Labs & Diagnostic Tests
Elevated WBC Elevated bilirubin in serum & urine Prolonged PT resulting from interference with vitamin K absorption

Alkaline phosphatase, serum amylase levels to differentiate between gallbladder & pancreas Serial enzyme tests & ECG heart disease Calculi observed on USG

PAIN PHOTO ABDOMEN

ULTRASONOGRAPHY

Case 3

denotes the GB wall thickening denotes the fluid around the GB GB also appears distended

Complications of acute cholecystitis

Empyema of gallbladder
Emphysematous cholecystitis

Pus-filled GB due to bacterial proliferation in obstructed GB. toxic, high fever More commonly in men and diabetics. Severe RUQ pain, generalized sepsis. Imaging shows air in GB wall or lumen Occurs in 10% of acute choly, usually becomes a contained abscess in RUQ Less commonly, perforates into adjacent viscus = cholecystoenteric fistula & the stone can cause gallstone ileus

Perforated gallbladder

PENGOBATAN = Puasa/ bed rest = Nutrisi parenteral = Pain killer gol. Meperidine = Antibiotik sistemik = Kolesistektomi

TERIMA KASIH