Caile biliare

apr-ox@5t.dinaduftipreEmtaEkariAlBmmera.t
-

↳
:mm.ee

originea-diverticulalproenteronukfbdinaizmuug.fratin
iEnagtere →

→
pancreas ventral

÷:÷÷:÷÷:÷:÷÷÷÷÷
→ veziculabiliara

fundiorpgiaet
-

apro-x.s-omlbilacoindesledestims.ci
Heisler
-

canalulcistioaretmimleriorvalvdespirale

lighepatoduodenal P

DR .
porringer STG .
1. Arteracistica
sedesprimdedin
artera
artera
hepatica

dreap_ta@tff.CMP
←

T hepatica
'

proprie
Anterior
.su#/tgiY7yE-o
www. i f- M MBpgq. f m
←

nqagqawoeo-o-i.in
trauma #
"

canal hepatic
German
cistic

-
CBP trece primped pancreased ai si se uneg le
-
la 1am
de du U1 pancreatic
Cele asedeschidtm D② prim Arm
pula Lui Vater

&&
EPIDEMÉDLOGIE
-

incident cregtecuvarsta
a

- de
31 Mai J ta Ot
-

timdesñprezimleagregare familiala'
1. Bc ca
impliesarea ileonului terminal +
incidental B
[ botilehemotiticecirozaako-ote.ca/calaetipigmen--ari !
 PAT0-Gcizibiliari.lecitina-gicotester-l-srmodif.
E_NiE.calculimicgti-ce1rmai0tipl75t@bsco-nIin.a de
component-0M duc la
Ct ale
.

for Marea gi precipitatea Cristalelardecoteslerot

ocazional formearea
'
olim
se
singur caked de
→
un .

arescute ,
campusape im tmtregime
din contester ol 4. cotesterolsolitar

.cat#eformear-oitmvBd-ar} .statabiliara
1. Maj

po-tpredisp.la/-orrmarea.imfecIiacalculilortmafaravB
calculii 120%7 Jim
pigmentare negri at Mai
-

[ bruni
→

sludge biliar
cotecist r1Mimfectilebi1ei_laparimceile@iosuntmoi.r
adioopaai)
=

mucoprotein
}
↳
imdelungatei
•
NPT

→ cristate decotesterot •
intometare
→ bilirubinat de ca et
pend rapidoi
.
t-VAULAREDIAGNOHTCA.ie/er-atecIiunehepat-ocelulara
\ obstaa-lmecanicneoplaziasubiacenl.ci
! Celica biliara = durerea
-
Constanta , several ,
totalizator Tm HD .
uneori
outrange Arm
! Pacient
,1-4h② nelinigtit I
de
tip visceral droit O are
sup
-
,

consecimt.at pre siunii

- .

in VB

esleaso-ciatacuimhama.tk/im1estie-aparedeobicei
-
mu

postprandial

imsotita-de@vmmoaco1ecistita-simf1ama.tia
-

+
infectia VB
acuta
→ aware la palpare agravataptgresiv
,

→
iritatia peritoneal uiparie.to#
→ GIV rmanif Sidonia
+ .

scalene acetic + urine coterie

obstaaetpecaile biliare
-

extra
hepatice
→

tondimtapaeientuluideanuseme.sc# !
•rice ti
miscare ace . durerea

sermon
Murphy ⑦
-

↳
oprireabruscaaresp.la palparea profunda
'
rm HD
 • hi
per bilirubin movie
→
directa- ( coastal d)
↳ indirecta- ( bolihemotitice )
• FAR → e-bstr .
biliara extrahepatica
↳ biliara :
stabilitatelalemp.ride.ca/e@ !
•
GGT : Tm para let FA Al

•
IN RT :
icterobstructivlmalabs.irit K) .
&
1. Neo primitiv / metastatic → FAT
↳ bilirubin a normed
• Hb , Ht 9 →
pacientdeshidratat
•
hiperleucocitozacu derriere la⑤g→ imflam.li#egtie
• amita7- a / lipata user ores cite→

↳ mai ] Tim pancreatitis Ac .

→
t.ca#a →
investigation dee1e
→
son sib .
/ specific tale de 95% !!
→

Ñpñnala3lge briar
→ Calea bi tiara dilatatoi coined > 7cm
→
perelecotecisticimgro-gattlichidpou.ae lecistic
cotecistita acuta

-
RI : dim calculi sunt vizi-be.pe#mp1a-

:::÷÷÷e
→ colecistita acuta ermtizermatoasa Caer im
-

I :
exduderea altar cauze de OB
1dg -
alternator
↳
cotangio a-
-

MRI :
investigate✓ÉtmÉPTsau
ERCP
↳ mu-esleimvaziva.mu implied radigtii
biliaracu radio nuclizi
HiDA_ :
scimtigrafie
↳ cotecistul normal se rede Tm 30min
→ son sib .
95-97-1
↳
.

specif . : 90 -97%
→
fats ceicumutritie parenterala- / hepatita
⑤ →

→
poate identified f.stale
PIC action trans cutan si transparietal im paunch
: .
-

hepatic gi injectareas c. direct im ductile

beware intrahepatice
→ dude dilatate → success 95-1 .

↳ calibre normal → success 70-80-1

maialespt.catelerizareasf.dddigiimjectareas.e.pt
vizuatizarearborepro-ximal@t-R_cP.o
.

a obtineoimiag.la arborduibiliargi
- -

pancreatic
epeFstincterotomiei@H.o
•

extract Orbeliani
ia calculi
mum
☒ Litiaza reticular a- asimptoomatica
-

majoritatearñmñnasimptomatici

÷÷÷:÷:÷÷:÷:±÷_
- calecislectomia profitactive@ este recoman data I
.

-
aetici biti are r is all de com
plicqtii t

☒ cotecistita acuta
-

obstructie persistenta- cuimtlam.si intestine

-

depa's este peritoneal visceral peritonealparietal →

Aurore Constanta HD sail

-

,
Tm
epigastric ,
Al

uma-rgiscapula-greturitvarsaturi-sdr.fdbril-sonsib.la
iradiere im
spate ,

tmHD.sermmMurphytO@1.Dg
+ •
palpare
patita acuta
he o
apondicita
a
pancreatic acuta • ulcer per forat

ECI : • distension VB

tmgros area peretduicotecistului I > 3- 4mm) =

•
lichidpericoiecistic
• sermon
M_mphy ( Ia 98 %)
oral
tr oprire aport alimentan
} initial
: →

/
→

→
adorn iv. de tichide

terapie AB
.
apai :

→ Colecistectomiaprec-alla-aeaie.de la prez)

→ cdecistostomie →
ai im stare
gravñ
↳ tub de Aron prim ticat Tm B-

! Cotecistita acuta
qangi → mortal itate 20-25-1
↳ morbidtale
.

15-25-1 .

! ! Cotecistita acuta emtizermatoasa :

proBTWpectrulargpt.am
-ducg@ovoirstnici.2d-5oi.aso-ciataDZOd.A
• bader ii anaerobe care

aerabi
• aetecistectomia de
argentum
☒ Cotecistita cronica
maid
litiazaco-lecisticasimpt-episoademimobstruct
for moi
ore.repetale.de
-
ce a de
ie a canal ului
cistic in
Hamartia +
fibr-zapereteku.vn
• Celica bi tiara

• GIV pet rmsotidurerea

±
intoleranta la aliment tii,f1atukn
siim.de#tie-absonIa-euae-cito-zei
US confirm a- dog im dim
cap uri
-

In : controlled dureriigi monitori 2-are

 -
cotecistectomia la
para elective
-
cei care auisto-ricdeimterv.pe abd .

classic
*
tr.no#irurgi-al :

la 151 dim
pacienti
• .
( mutotereaza chirp
• ESKIL llitotristie extracorporeala)

ursodeoxicoticlfsaturareabileicucoteslerotprin-secr) .de
• acid
coletterot
↳ min 6 lumi → 1am

•
Litiazacotedotianagicalangita acuta
-

primarasausecundara
-

coteda@litiaEaTEcibiliaresobstrugtie.calangita ,

pancreatitis

asimpt-icterulfhc-unl-co-langita cuta-simf.aeEs
-

50-1 sunt .

-
triada Charcot / pentad a
Reynold
an
Klebsiella
1. Sensibilitalea la decamp re sie
nuapare
-
Sdr Mi rizzi
. → an calciumare cam
prima canalul

hepatic comune

dilator i cat biteare intra / extra

hep
'

eat : •
.

• calculi TM VB

•
Mrcpitrcpsaptc → Cele Mai utile exptorari
•
TRAI :

litiazacdedocianat-A-RA.co/angita=ycdecistectomielaparo
 cuadangiogr.imtrao-p.si
exp
to rare CBP

colangita acuta supinator :

reech HE
4
•

internare Ati
.

+
o AB me

'

• re co Hare homeculture

dezech.decd-agularetcotecistectomie@aceserecupereaza1.DA
•
vitksauPPC.pt .

OF NU RA'SPUND
-

deae-rmpresiebiliarapr.im ERCP
stent trans cutan
-

hepatic per
-
Chi ru deschisa

! endoluminala calculi mari

Litotritie →

☒ Pancreatita acuta bibiana

-
bot .
,
Mai Ates la I
-
otsstr tranzitorie / persistenta- a canal ului
.

pancreatic ,

la nivelul Ampule i Vater

im
special
durere abdominala' met
superior
.

sonsib.la abd
•
palparea .

•
greturi Ivars a-turi / febrñ
scar Ransom
-

u-gqaErata.co/ecistect.1aparotm48-72hO
abs inter v.
↳ im .
→
60-1.rea.de#aza-
 aesfimcterotomieendo-sc-opicaldrecurentala2-s-t.im )
-

Sevier : •
ERCP
arm .
Zani

• AB

☒ ILEUSUL Bill Ape

dim
capwrite de oduzie intestinala-
- erodarea peretetui VB de coitre un caked care

intestine (de obicei duoden) )

patrwnde im

digestive fistula bilio -

calcululmigrear-a-giseimpacteaza.pro#immal
a-
de rawa ileo -
cecal
- Mai J la 9- ( 3,5 1) :

-
tabloid wneioduzii intestinal
etma④
RI arb bi liar
Abstract a intestinal ui
-

: aertm .
+

! ctcusc
↳
→

imvestigqtiadeeled.ie
aerobilia
→
fistula bilio -

dig .

→ lotul obstr .

→ calculul impactat
sonDoi Na
Ih : •

pt.de comp retie

• hi dratare iv.
-

laparotomies exp 1- cutmdepartare calculi

mobilizamdu-lcd-gradeatreoenterot-mie.im
imtestimsamato-s-expl.im#uiimetinpt-ajtica1cu1i
 Cancerul veziculei biliare

ce1mai0canceraltractuluibiliar-al@leacc.Gi
-

- main lab 13 : 1)
-
30%
tmtirmpulcotecistectormiei@Hlscc.se
dg .
incidental

rega-segte.im pie 0,3 -

1% din to ate sele de
Cole cistectomnie
darere TM HD similara- centeredare dar
cuep
-
-

mai persistenta-
-
I ponder at a' ,
Henie
a

-
icter (50-1)
a CT i
§ MRCP → extension botii , metastasize
¥ :
•
cdecislectomie a imide mezegtie -0
marg
limdusiv
margined canal uluicistic)
• tamai mari, cuextonsie →
rezegtie hepatica
cuneiform a- a
patuluicotecistic
si limfadenectomie regionala-
tu avansate
• →
rezegtie hepatica formala-
rata de la Sani <
5-1
supra v.
-
→
.
Afectiunile maligne ale cailor biliare

cotangiocarci mom
Gi
-
3% dim me
optative
• extra
hepatic ( go %) →
peri bitar 150%7
↳ distale ( ko %)
segment -_

• intra hepatic 110% )

-
voirsta : 50-70 ani

-
113 an utiapa reticulara- asotiata
• adenocarcinoma care pro duc Mru Cima
↳ dezvoltare tenta ,
ran metal a distanta-
→ imvazie local a-

Clinic → icter → ur ima hipercroma

writ scalene acotice
pr
→ →

! Icier progresiv
-
sermon Courvoisier → obstr distala-
.

! Eau
ceamaiutilaimvestigat.ie initiala-
-

Td :
prognostic rezervat 15-10%1 sarin a

hep rezegtii hepatice cnn.me

g. 30%7
-
intra : <

peri nilare :

rezegtiigihepatico-jejunanast.pe
-

②sdmYa1aR#x
-
soul
±
stent
hepatica
rez .
-

cBPdistal_ :

operqtia Whipple ( DPC)

rezegtie CBP distal detdek
cap pancreas
-

, ,

12 -25%
supra v.
-

mere-zec.by pass Chirurgical

- Sau
☒ believe
saoppaliativ