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CLINICAL MANIFESTATION
KOLESISTITIS AKUT
Adalah reaksi inflamasi akut dinding kandung empedu dgn ditandai adanya: = Nyeri perut kanan atas = Panas badan Faktor yg berperan : = stasis cairan = infeksi kuman = iskemia dinding
PEMBAGIAN
Berdasar penyebab dibagi 2: = Kolesistitis akut kalkulus : (90%) terjadi karena ada batu yg menyumbat ductus cysticus = Kolesistitis akut akalkulus : didapat pd pasien yg dirawat cukup lama dan dgn nutrisi parenteral, keganasan GB, atau merupakan komplikasi demam tifoid atan DM
GEJALA KLINIS
Keluhan dan tanda yg khas adalah : = Kolik perut kanan atas = Nyeri tekan perut kanan atas = kenaikan temperatur = Rasa sakit menjalar ke pundak atau scapula kanan = Murphy sign positif
MURPHY SIGN
Pasien terlentang dan pemeriksa ada di sisi kanan penderita Dilakukan penekanan dengan tangan kanan di perut kanan atas, tahan pada posisi ini, dan pasien diminta menarik nafas dalam : nafas terhenti krn pasien kesakitan, Murphy sign positif
Diagnosis
History Physical exam Labs & Diagnostic Tests
Elevated WBC Elevated bilirubin in serum & urine Prolonged PT resulting from interference with vitamin K absorption
Alkaline phosphatase, serum amylase levels to differentiate between gallbladder & pancreas Serial enzyme tests & ECG heart disease Calculi observed on USG
ULTRASONOGRAPHY
Case 3
denotes the GB wall thickening denotes the fluid around the GB GB also appears distended
Pus-filled GB due to bacterial proliferation in obstructed GB. toxic, high fever More commonly in men and diabetics. Severe RUQ pain, generalized sepsis. Imaging shows air in GB wall or lumen Occurs in 10% of acute choly, usually becomes a contained abscess in RUQ Less commonly, perforates into adjacent viscus = cholecystoenteric fistula & the stone can cause gallstone ileus
Perforated gallbladder
PENGOBATAN = Puasa/ bed rest = Nutrisi parenteral = Pain killer gol. Meperidine = Antibiotik sistemik = Kolesistektomi
TERIMA KASIH