colecistitis aguda y cronica. fisiopatologia
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Presentacion 2013, de colecistitis aguda y cronica sobre fisiopatologia, tratamientoTRANSCRIPT
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COLECISTITIS AGUDA Y CRÓNICA
INSTITUTO MEXICANO DEL SEGURO SOCIALHOSPITAL GENERAL REGIONAL 46
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Colecistitis aguda Sindrome con dolor en CSD, Fiebre y leucocitosis + inflamación de la
vesicula (por cálculos biliares)
Colecistitis acalculosa Sindrome con dolor en CSD, Fiebre y leucocitosis + inflamación de la
vesicula
Colecistitis crónica Término utilizado por patólogo para describir la infiltración de células
inflamatorias crónicas de la vesícula biliar
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FACTORES DE RIESGO
1H : 2M
Obesidad
Embarazo
Dieta
Enfermedad de Chron
Reseccion de ileon terminal
Operación gástrica
Esferocitosis hereditaria
Enfermedad de células falciformes
Talasemia
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Prevalencia 11 – 36%
3% sufren un cólico anual
3 – 5 % complicada
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FISIOPATOLOGÍA DE LA LITIASIS VESICULAR
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Calculo biliar Inflamacion y edema
Lisolecitina
Formación de cálculos biliares Colesterol - 80%
Pigmento
Negros 15 – 20%
Pardos 1 – 5%
Escherichia coli secretan glucuronidasa β
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MANEJO Y DIAGNOSTICO
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COLICO BILIAR
Ingesta de alimentos grasos (50%) 1 hr antes
Dura de 1 a 5 hrs
Nauseas y vomitos
Laboratorio: normal
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COLECISTITIS AGUDA
Dolor >4 – 6hrs
Fiebre
Anorexia, náuseas y vómitos
Rehúsa moverse
Signo de Murphy
Leucocitosis 12.000 – 15.000
> 20 = Colecistitis complicada
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DIAGNOSTICO
Ecografia S y E 95%
Pared de la vesícula biliar (más de 4 a 5 mm ) o edema ( signo doble pared)
“Signo ecográfico de Murphy "
Laboratorio BH
PFH
Bilirrubinas
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Colecistogammagrafía tecnecio ácido
iminodiacético hepática ( HIDA )
S 97% y E90%
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Colescintigrafía morfina
Colangiografía por resonancia magnética Calculos en cistico S 100% - Grosor de la pared S 69%
TAC Diagnostico diferencial o complicaciones de la colecistitis aguda
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DIAGNOSTICO DIFERENCIAL
Cólico biliar
Pancreatitis aguda .
Apendicitis .
Hepatitis aguda .
Enfermedad ulcerosa péptica .
Enfermedades del riñón derecho .
Neumonía del lado derecho .
El síndrome de Fitz -Hugh- Curtis
Absceso Subhepático o intraabdominal .
Víscera perforada .
Isquemia cardiaca .
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COMPLICACIONES
Gangrena de la vesicula biliar - 20% Perforacion 2%
Fístula colecistoentérica
Íleo biliar
Colecistitis enfisematosa
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TRATAMIENTO
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Líquidos iv
Antibioticoterapia (Infectious Diseases Society of America (IDSA)) Laboratorio
Fiebre
Enfisema
Colecistectomia
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Regimen Dose (adult)*
First choice
Monotherapy with a beta-lactam/beta-lactamase inhibitor:
Piperacillin-tazobactam • 3.375 or 4.5 g IV every six hours
Ticarcillin-clavulanate 3.1 g IV every four hours
Combination third generation cephalosporin PLUS metronidazole:
Ceftriaxone plus 1 g IV every 24 hours or 2 g IV every 12 hours for CNS infections
Metronidazole 500 mg IV every eight hours
Alternative empiric regimens
Combination fluoroquinolone Δ PLUS metronidazole:
Ciprofloxacin or 400 mg IV every 12 hours
Levofloxacin plus 500 or 750 mg IV once daily
Metronidazole 500 mg IV every eight hours
Monotherapy with a carbapenem ◊ :
Imipenem-cilastatin 500 mg IV every six hours
Meropenem 1 g IV every eight hours
Doripenem 500 mg IV every eight hours
Ertapenem § 1 g once daily
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LINEAMIENTOS DE TOKIO
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INDICACIONES DE COLECISTECTOMÍA
Indications
Symptomatic cholelithiasis
Biliary colic, acute cholecystitis, gallstone pancreatitis
Asymptomatic cholelithiasis in select cases
Sickle cell, TPN, immunosuppression
Acalculous cholecystitis
Gallbladder dyskinesia
Large gallbladder polyps
Porcelain gallbladder
Contraindications
Absolute
Inability to tolerate general anesthesia, peritonitis with hemodynamic compromise, refractory coagulopathy, gallbladder cancer
Relative
Previous abdominal surgery, pregnancy, morbid obesity, cholangitis, severe comorbidities