The effect of cholecystokinin on the gallbladder and the sphincter of Oddi. A.

During fasting, with the sphincter of Oddi contracted and the gallbladder filling. B. In response to a meal, the sphincter of Oddi relaxed and the gallbladder emptying.

AAA, abdominal aortic aneurysm.

Emergency Surgery, Adam Brooks, 2010

Case File Surgery, 3th Ed, 2009

Gallstones 5Fs Fat, female., fair, fertile, forty

Equilibrium phase diagram for bile salt lecithincholesterolwater at a concentration of 10% solids, 90% water. The monomeric phase is not depicted as a phase because it exists at the same concentration throughout. The one-phase zone contains only micelles. Several other zones exist, but only the two on the left above the one-phase zone apply to human gallbladder bile, and both contain cholesterol monohydrate crystals at equilibrium.

Scheme showing pathogenesis of cholesterol gallstone formation. Conditions or factors that increase the ratio of cholesterol to bile acids and phospholipids (lecithin) favor gallstone formation. HMG-CoAR, hydroxymethylglutarylcoenzyme A reductase; 7--OHase, cholesterol, 7-hydroxylase; MDR3, multidrug resistanceassociated protein 3, also called phospholipid export pump

Floating gallstones. A: Sagittal scan. B: Transverse scan. Scans show multiple hyperechoic structures (arrowheads) floating in the lumen of the gallbladder

80% of gallstones are cholesterol stones and about 15 to 20% are black pigment stones

(A) Cholesterol gallstones. (B) Black pigment gallstones. (C) Brown pigment gallstone.

90-95% kolesisititis akut disertai batu empedu Kolesistitis akut tanpa batu empedu: jarang

Batu empedu
Distensi Edema Inflamasi

Kholesistitis akut Perforasi Peritonitis

Gambaran Klinis
Nyeri kolik bilier yg tidak berkurang bertambah nyeri Demam, anoreksia, nausea dan vomitus Nyeri bertambah bila bergerak Nyeri tekan dan nyeri lepas perut kanan atas Murphys sign Lekositosis 12.000 15.000 /mm3 Bilirubin, alkali fosfatase, transaminase dan amilase meningkat Ikterus

2/3 batu empedu

kolesistitis kronis

Gambaran klinis
Nyeri : konstan, hilang bbp jam (5 jam) Lokasi epigastrium, perut kanan atas, menjalar ke punggung / skapula Datang tiba-2 ssdh makan (lemak) Disertai nausea dan vomitus Nyeri tekan perut kanan atas, nyeri lepas (-) Sering diagnosis keliru dengan gastritis, (maag) diberi obat maag.