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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/l15
• PROTEINE 200 mg
• AC. BILIARI 40-100mM/l110
• COLESTEROL 2-5mM/l25
• FOSFOLIPIDE 5-10mM/l50
ACIZI BILIARI
PRIMARI: COLIC; CHENODEZOXICOLIC
SECUNDARI: DEZOXICOLIC; LITOCOLIC
TER|IARI URSOCOLIC; URSODEZOXICOLIC
ZONA DE STABILITATE:
• 8% COLESTEROL
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
3. CRE}TEREA
CLINIC~
1. ASIMPTOMATICI 50%
2. DISPEPSIE
3. COLIC~ BILIAR~
FACTORI PRECIPITAN|I
GR~SIMI)
• 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
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
1. MEDICAL - OPIACEE
2. COLECISTECTOMIE LAPAROSCOPIC~
3. LITOTRIPSIE:
- ESWL
- PER ENDOSCOPIC~
4. DISOLU|IA CHIMIC~
II. LITIAZA C~II BILIARE
PRINCIPALE
1. SIMPTOMATIC~
3. COLECISTECTOMIA LAPAROSCOPIC~
SIMPTOME
TRIADA CHARCOT:
1. COLIC~ BILIAR~
2. FEBR~
3. ICTER
ANOMALII BIOLOGICE
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