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  • Oditrio Irawan - Cholelithiasis

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    Ny. S, a 65-year-old woman, presented with suspected cholelithiasis. An ultrasound showed her liver, bile ducts, and blood vessels were normal size and shape with no masses. Her gallbladder was also normal in size with smooth walls and no thickening. A 0.8 cm hyperechoic lesion with distinct borders and acoustic shadowing was seen in her gallbladder, consistent with a gallstone. Cholelithiasis is the presence of gallstones in the gallbladder or bile ducts. Risk factors include obesity, older age, female sex, and fair skin. Gallstones form when bile becomes supersaturated, nuclei form, crystals develop, and stones grow. Sympt

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    16303 - Oditrio Irawan - Cholelithiasis

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    Ny. S, a 65-year-old woman, presented with suspected cholelithiasis. An ultrasound showed her liver, bile ducts, and blood vessels were normal size and shape with no masses. Her gallbladder was also normal in size with smooth walls and no thickening. A 0.8 cm hyperechoic lesion with distinct borders and acoustic shadowing was seen in her gallbladder, consistent with a gallstone. Cholelithiasis is the presence of gallstones in the gallbladder or bile ducts. Risk factors include obesity, older age, female sex, and fair skin. Gallstones form when bile becomes supersaturated, nuclei form, crystals develop, and stones grow. Sympt

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    33 views17 pages

    Oditrio Irawan - Cholelithiasis

    Uploaded by

    widiya
    Ny. S, a 65-year-old woman, presented with suspected cholelithiasis. An ultrasound showed her liver, bile ducts, and blood vessels were normal size and shape with no masses. Her gallbladder was also normal in size with smooth walls and no thickening. A 0.8 cm hyperechoic lesion with distinct borders and acoustic shadowing was seen in her gallbladder, consistent with a gallstone. Cholelithiasis is the presence of gallstones in the gallbladder or bile ducts. Risk factors include obesity, older age, female sex, and fair skin. Gallstones form when bile becomes supersaturated, nuclei form, crystals develop, and stones grow. Sympt

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    of 17

    Laporan Pagi

    Cholelithiasis
    Oditrio Irawan
    12/338809/KU/15345
    Kelompok 16303
    Identitas Pasien
    • Nama : Ny.S
    • Tanggal Lahir : 14/10/1952 (65tahun)
    • Alamat : Cilacap
    • No.RM : 01.84.5x.xx

    • Keterangan klinis : susp cholelithiasis


    • Permintaan radiologis : usg upper & lower abdomen
    USG
    ● Hepar : Ukuran dan echostructure
    normal, permukaan licin, sistema
    bilier dan vaskuler intrahepatal tak
    prominen, tak tampak massa/nodul.
    Tampal lesi anechoic di intra pleura
    dekstra dan hepatorenal space
    ● Vesica felea : Ukuran normal,
    dinding tak tampak menebal, tak
    tampak massa maupun sludge.
    Tampak lesi hiperechoic dengan
    bentuk amorf, batas tegas, tepi
    licin dengan ukuran Lk 0,8 cm,
    accoustic shadow (+)
    TEORI
    ANATOMY
    Gallblader
    • Fundus
    • Corpus
    • Infundibulum
    (Hartmann’s Pouch)
    • Collum (ductus cysticus)
    CHOLELITHIASIS
    • Definition
    “penyakit batu empedu yang ditemukan di dalam kandung
    empedu atau di dalam ductus koledokus atau pada keduanya”
    (de jong, 2010)
    RISK FACTOR
    • FAT (BMI >30)
    • FORTY (Age >40)
    • FEMALE
    • FERTILE
    • FAIR (More prevalent in Caucasian)
    Cholesterol Stones
    Theory of stones formation
    1. Supersaturation of the bile
    2. Nidus formation
    3. Crystalization
    4. Growth of stones
    Cholesterol Stones
    1. Supersaturation of the bile
    a. Increase secretion of
    cholesterol : obesity, diet
    high in cholesterol,
    medicine that contain
    estrogen
    b. Decrease bile
    acids/phospholipids :
    malabsorption in ileum
    Cholesterol Stones
    2. Nidus formation
    • bile pigment
    • Bacteria
    • Foreign body
    3. Crystalization
    4. Growth of stone
    • precipitation of crystal
    cholesterol over inorganic matrix
    Pigmented Stones
    • Calcium billirubinate
    • Increase of conjugated bilirubin in
    gallbladder or liver in condition such
    as anemia hemolytic
    • Unconjugated bilirubin tend to
    precipitate with calcium
    Clinical symptom
    • Asymptomatic in 90% patient
    • Symptomatic
    - Pain and tenderness in the right upper quadrant
    - Pain frequently radiated to the right scapula or shoulders (Boa’s sign)
    - Pain associated with fatty meal
    - Pain worsens with deep breath (murphy’s sign)
    - Icterus (in Mirizzi syndrome)
    USG: Normal Gallbladder
    • Elliptical sacs
    • Fluid filled sonoluscent lumen
    surrounded by echogenic wall
    • Fasting gallbladder is about 4 x
    10 cm in size
    • The wall is no thicker than 3 mm
    USG: Cholelithiasis
    • Stones are acoustically dense
    and reflect the ultrasound
    waves back to the ultrasonic
    transducer.
    • Acoustic shadow : stones
    block the passage of sound
    waves to the region behind
    them
    MANAGEMENT
    Operative
    • Laparoscopic
    Cholecystectomy
    • Open Cholecystectomy
    MANAGEMENT
    Indication for surgery
    • Symptomatic stone
    • Asymptomatic stone
    - with diameter >2cm  increase the risk of Cholecystitis
    - malignancy
    TERIMAKASIH
    MOHON ASUPAN 

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