Gall stone disease
Until the sixth decade, 20% female and 10% of men suffer from gallstones and its
prevalence increases with age, although it is generally always in women. In
Western societies, most found the stone is a stone of cholesterol or calcium
bilirubin-cholesterol mixtures. Pathogenesis is not completely understood.
however, factors which could form the bile faklor litogenik include an increase in
cholesterol content, reduced bile acid and bile stasis. In most cases, gallstones
are asymptomatic and only 10% have symptoms after 5 years. Gallstones cause three
major disorders: cholecystitis, biliary colic and koledokolitiasis.
Gallstone impaction in the cystic duct is a common cause of cholecystitis. Less
common causes of infection include Salmonella typhi or primer such as Ascaris
lumbricoides, trauma, surgery, chemotherapy and TPN.
Symptoms: right upper quadrant pain, often with spread to the right shoulder,
nausea, vomiting and fever.
Sign: RUQ tenderness pedestal, tenderness of the gallbladder that can be shown on
inspiration (Mark Murphy), gallbladder usually can not be touched, and jaundice in
a minority of patients.
• FBC investigations usually show a leukocytosis • Abdominal X-rays showed stones
radioopak on a minority of cases and sometimes a sentinel-loop or the presence of
air in the biliary branches • U.S. showed gall bladder stones and darts mucosal
thickening • Skaning radio-isotopic (HIDA; PIPIDA) is useful in finding the cystic
duct obstruction dart.
Complications Empyema, gangrene and perforation of the gallbladder, pancreatitis,
abscess perihepatik, piemia port and septikemi.
At first supportive management with iv fluids, analgesics and antibiotics, such as
amoxicillin and tobramycin. Cholecystectomy is performed after the patient is
stable, although the selected treatment time of surgery is done early or delayed
cholecystectomy (interval) is still controversial and depends on the condition and
age of the patient. Percutaneous cholecystectomy
may be indicated in patients with severe pain.
This situation is usually caused by impaction of a stone in the cystic duct.
Symptoms: Pain that persists in the epigastrium or right upper quadrant are
usually intensified during 2-3 hours before it subsided.
Pain is more than 6 hours of support in cholecystitis. Often found nausea and
Investigation Diagnosis is made clinically most especially because of gallstones
is frequent. Many patients with gallstones and dyspepsia was not helped by
cholecystectomy and in many patients, abdominal discomfort caused by IBS (hepatic
flexure syndrome) • transient increase of bilirubin and alkaline phosphatase
support the diagnosis of biliary colic biliary • Scintigraphy can show if the
cystic duct obstruction carried out during the attack.
Provide management of analgesia until the attack passes. Morphine increases
sphincter of Oddi pressure and should be avoided. Cholecystectomy is indicated in
patients who underwent surgery powerful. In patients who are not strong or refuse
surgery, therapy can be administered by the acid dissolution of gallstones
ursodeoksikolat for patients with radiolucent stones of less than 1.5 cm in
diameter and with a rnasih gall bladder function at oral kolesistograti. Complete
dissolution occurred approximately 30% at 12 months.
Koledokus duct stones most often derived from gallbladder stones, but can form in
the bile ducts due to biliary stricture, cholangitis or primary or secondary
sklerotika in Caroli disease.
Clinical picture can be asymptomatic
Symptoms include biliary colic, intermittent or constant pain in the right upper
quadrant, nausea and vomiting.
Signs: fluctuating jaundice, right upper quadrant tenderness and a palpable
gallbladder in 15% of cases. Fever and rigor indicates cholangitis.
Investigas! • FBC and LFT show a leukocytosis shows an increase of bilirubin,
alkaline phosphatase and gamma GT; not infrequently found a slight increase of
transaminases • Often tedadi elongation PT • Abdominal X-rays may show an opaque
or a rare stone, showing air in the biliary branches • U.S. can demonstrate
dilated biliary branches, but not as sensitive in identifying stones in the CBD
which usually require ERCP or PTC.
Penyullt pancreatitis, cholangitis, septikemi, and hepatic abscess secondary
sklerotika cholangitis or biliary cirrhosis.
First of all give the management of analgesia, iv fluids and antibiotics (eg
amoxicillin or tobramycin). Removal of the stone best with ERCP, sphincterotomy
and extraction with a Dormia basket or balloon. Large stones can be dissolved or
reduced in size by methyl-tert-butyl-ether or mono-octanion given through a tube
nasobitiaris. Stone fragmentation by mechanical lithotripsy may prove useful as an