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PATOLOGIA

C~ILOR BILIARE
I. LITIAZA BILIAR~
• EPIDEMIOLOGIE:
- FEMEI
- V^RST~: ♦ 0-20 0,1%
♦ 70 – 80 34%
• In Europa 10- 20% din populatie
• 40% simptomatici
• 700.000 colecistectomii/an U.S.A
• 185.000 colecistectomii/an Germania
CLASIFICARE:

♦ COLESTEROL 80%
♦ PIGMEN|I 10-15%
♦ MIC}TI
CONSTITU|IA BILEI NORMALE
• ELECTROLI|I 25-50mEq/l
• BILIRUBIN~ 0,25-1mM/l→15
• PROTEINE 200 mg
• AC. BILIARI 40-100mM/l→110
• COLESTEROL 2-5mM/l→25
• FOSFOLIPIDE 5-10mM/l→50
ACIZI BILIARI
PRIMARI: COLIC; CHENODEZOXICOLIC

SECUNDARI: DEZOXICOLIC; LITOCOLIC

TER|IARI URSOCOLIC; URSODEZOXICOLIC

URMEAZ~ CICLUL ENTEROHEPATIC


Sinteza de novo:

Reprezentarea schematica a metabolismului colesterolului la mamaifere


RAPORTUL ADMIRAND
SMALL

ZONA DE STABILITATE:

• 8% COLESTEROL

• 40% AC. BILIARI


FACTORI DE RISC
COLESTEROL
1. DEMOGRAFICI: OCCIDENT
2. OBEZITATE
3. DIETA
4. MEDICA|IE HIPOCOLESTEROLEMIANT~
5. BOLI INTESTINALE
6. HORMONI ESTROGENI
7. SARCINA
PATOGENIE
• Nidarea e functie de solubilitatea
coletero lului, cantitatea de mucus si
motilitate
• Genetica moduleaza transportorul
ABC-B4
FACTORI DE RISC
PIGMENTARI
1. DEMOGRAFICI: ORIENT

2. HEMOLIZ~ CRONIC~

3. CIROZ~ ALCOOLIC~

4. INFEC|II BILIARE

5. V^RSTA
PATOGENIE
• β- glicuronidaza bacteriana
• Deconjugarea in colon (b.CROHN)
• Asocierea promoterului UGTA A (Gilbert)
LITIAZA RECUNOA}TE
3 TREPTE

1. FORMAREA BILEI SUPRASATURATE

2. NUCLEERE (OMOGEN~, NEOMOGEN~)

3. CRE}TEREA
CLINIC~

1. ASIMPTOMATICI 50%

2. DISPEPSIE

3. COLIC~ BILIAR~
FACTORI PRECIPITAN|I

• ABUZURI ALIMENTARE (CALORICE,

GR~SIMI)

• VIBRA|II (AUTO, C~L~RIT)

• CICLUL MENSTRUAL
• DURERE : 1. LOCALIZARE
2. IRADIERE
3. DURAT~
• V~RS~TURI
• FRISON
• FEBR~
• ICTER
DIAGNOSTICUL IMAGISTIC
1. ABDOMEN PE GOL
2. ECHOGRAFIA 97% > 5mm
3. COLECISTOGRAFIA PER OS
4. COLANGIOGRAFIA I.V.
5. COLECISTOGRAFIA HIDA, DISIDA
6. CT, RMN
7. ERCP
8. COLANGIOGRAFIA TRANSHEPATIC~
Ultrasonographic Images of Three Gallbladders

Strasberg S. N Engl J Med 2008;358:2804-2811


COMPLICA|II

1. COLECISTIT~ ACUT~

2. PANCREATIT~ ACUT~

3. FISTULE BILIODIGESTIVE

4. CARCINOM
COLECISTITA ACUTA
• Colica cu durata mai mare
• Patogenie : - initial numai obstructie;
- ulterior infectie cu Enterobacteriacees
- 80 % litiazice
• Clinica - durere in EPIGASTRU
- febra
- aparare musculara
- leucocitoza
- icter ;s.Mirizzi, coledocolitiaza
• Tratament 120.000 colecistectomii/an U.S.A.
Diagnostic Criteria for Acute Cholecystitis, According to Tokyo Guidelines

Strasberg S. N Engl J Med 2008;358:2804-2811


Severity Grading for Acute Cholecystitis, According to Tokyo Guidelines

Strasberg S. N Engl J Med 2008;358:2804-2811


Severity Grading for Acute Cholecystitis, According to Tokyo Guidelines

Strasberg S. N Engl J Med 2008;358:2804-2811


A 70-year-old man with a history of heart disease, hyperlipidemia, and diabetes mellitus
presented at the hospital with a 4-day history of increasing abdominal pain, nausea, and
vomiting

Shrestha Y and Trottier S. N Engl J Med 2007;357:1238


Ileus Biliar
An 83-year-old woman was hospitalized with nausea, vomiting, and obstipation

Graham J and Rothwell B. N Engl J Med 2004;351:1119


TRATAMENT

1. MEDICAL - OPIACEE
2. COLECISTECTOMIE LAPAROSCOPIC~
3. LITOTRIPSIE:
- ESWL
- PER ENDOSCOPIC~
4. DISOLU|IA CHIMIC~
II. LITIAZA C~II BILIARE
PRINCIPALE

1. SIMPTOMATIC~

2. ETIOLOGIA PANCREATITEI ACUTE

3. COLECISTECTOMIA LAPAROSCOPIC~
SIMPTOME

TRIADA CHARCOT:

1. COLIC~ BILIAR~

2. FEBR~

3. ICTER
ANOMALII BIOLOGICE

1. COLESTAZ~ (FA, γ GT)

2. CITOLIZ~

3. AMILAZE

4. LEUCOCITOZ~
DIAGNOSTIC IMAGISTIC

1. ECHOGRAFIE 55-75%
2. CT; COLANGIOSCANNER
3. RM
4. ECHOENDOSCOPIE
5. ERCP
TRATAMENT

1. SFINCTEROTOMIE

2. EXTRAC|IA CALCULULUI

3. LITOTRIPSIE

4. CHIRURGIE