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Cholelithiasis Essentials of Diagnosis Often asymptomatic.

. Classic biliary pain characterized by infrequent episodes of steady severe pain in epigastrium or right upper quadrant with radiation to right scapula. Detected on ultrasound. Epidemiologi Wanita > ria !mur "#$%& tahun %'( batu pigmen )%( batu *olesterol Etiologi +en ,-./ ut* efisiensi penyimpanan lema* 0utasi geneti* 1is* 2actor Wanita 3ative 4mericans +eneti* !mur > 5& th Obesitas 1apid weight loss 6D07 -nsulin resistance /igh inta*e of carbohydrate Cirrhosis hepatis /epatitis C /ypertriglyceridemia motilitas vesica turun Ceftria8one Clofibrate Octreotide Chron9s Disease inflamasi ileum bile salt resorption turun bile solubility turun gallstone uasa :$"& hari /amil dengan D0 dan obesitas 0anifestasi ;lini* 4simtomati* 3yeri epigastrium < *uadran *anan atas 6'& menit $: =am7 3ausea >omit /yperthermia ;andung empedu membesar .anda eritonitis

;lasifi*asi ". Cholesterol ;olesterol monohidrat > :&( +aram Ca? pigmen empedu? protein? asam lema* ). igmen6/itam dan @ilirubinat7 ;alsium bilirubinat *olesterol A )&( ;ara*teristi* Warna ;onsistensi ,o*asi enya*it enyerta Empedu ;omposisi Etiologi @atu igmen /itam Co*lat tua B hitam 4morf? beda* ;antung empedu dgn<tanpa saluran /emolisis Cirosis hati @iasanya negatif igmen ;alsium 2osfat ;alsium ;aronat E*s*resi >> /idrolisa con=ugated bilirubin @atu igmen Co*lat Co*lat tanah $ orange ,una* spt pasir? berlapis$ lapis Caluran empedu ;olangitis arasit ositif ;alsium @ilirubinat Cabun ;alsium 6asam lema* dari *olesterol7 /idrolisa un<con=ugated bilirubin oleh ba*teri

atofisiologi ;olesterol < bilirubin >> +aram empedu AA ;andung empedu hipomotil @ilirubin >> batu pigmen rodu*si *olesterol < bilirubin nai* rearbsopsi garam empedu turun *ompensasi tida* cu*up *elarutan *olesterol terganggu6empedu litogeni*7 6*olesterol harus ditranspor melalui7 micelle dan lecitin empedu =enuh *emampuan membawa *olesterol turun pengendapan *olesterol *ristal *olesterol batu emoedu 4namnesa ,o*asi nyeri 6@iliary pain "&$):(7 Durasi nyeri 6:5( "$: =am? '&( A " =am7 1iwayat *eluarga penya*it batu empedu enurunan berat badan yg terlalu cepat 0a*anan *olesterol >> emeri*saan 2isi* 3yeri te*an regio *anan atas < epigastrium /yperthermia ;andung empedu membesar

.anda peritonitisD nyeri tegang perut -*terus

emeri*saan enun=ang E$1ay !C+ 1adioisotop scan Operasi Oral cholecystography ,abD o o o o

D radioopaque D batu > )mm? bayangan opa* pada lumen

D ut* melihat motil *andung empedu? u*uran batu? *alsifi*asi

Direct bilirubin nai* ,eu*ocytosis 2eces acholia putih seperti *apur 4C.<4,.6C+O.<C+ .7 nai*

Differential Diagnosis @illiary pain 4cute cholecystitis Dyspepsia !l*us duodenum 4bses hepati*um 4cute 0yocard -nfarction -ndi*asi pengobatan ;alsifi*asi vesica biliaris +allstone > ' cm 4*an dila*u*an transplantasi =antung .atala*sana ,aparocopic cholecystectomy 6pulang sehari setelah operasi7 Open cholecystectomy Enterolithotomy pada pasien gallstone ileus 1is* operasiD reflu8 duodegastric < change intestinal e8posure to bile adenocarcinoma esofagus<usus halus pro8imal<colon Chenodeo8ycholic < ursodeo8ycholic acid selama ) tahun bila menola* cholecystectomy revent Caffeine !24 dan 0!24 ,ow carb diet? low cholesterol diet 4*tivitas fisi* /indari penurunan berat badan yang terlalu cepat Diet tinggi serat? tinggi *alsium

4spirin dan 3C4-D Ce*underD ursodiol? E8tracorporeal shoc*wave lithotripsy? statin

;ompli*asi 4cute cholecystitis '( dalam "& tahun erdarahan an*reatitis erforasi < -nfe*si saluran empedu
Cholelithiasis Cholelithiasis Cholesterolosis Gallbladder Adenomyomatosi s Porcelein Gallbladder Ac%te Cholecystitis Klinis Asymptomatic Biliary Pain Biasanya asymptomatic Bisa t d biliary pain !igh ris" Ca Gallbladder Biasanya asymptomatic Nyeri di &pigrastric$"%adr an "anan atas '%al( m%ntah( demam '%rphy Sign Biliary pain '%al Nyari "onstan pada epigastric$"%adra n "anan atas Asymptomatic Biliary pain .a%ndice /e0er Cholelithiasis pancreatitis Lab Normal Normal Normal Normal Normal Diagnosis USG USG Oral Cholecystograp hy Oral Cholecystograp hy #o $ CT Treatment

Le%"ocytosis

USG !)DA Scan

Chronic Cholecystitis

Normal

Choledeocolithia sis

Cholectatic li0er -1 test( le%"ocytosis( cholangitis 2( amilase dan lipase nai" pada pan"reatitis

* USG+cari bat%, * Oral Cholecystograp hy +non-%nctional gallbladder, USG '#CP &#CP

!)DA3 !epatic )minoDiacetic Acid4 '#CP3 'agnetic #esonance CholangioPancreatography4 &#CP3 &ndoscopic #etrograde CholangioPancreatography

rognosis )&( *ompli*asi FF( tida* re*uren bila dila*u*an operasi