Cholesistitis

CholesistitisPeradangan pada kandung empeduEtiologi: Batu kandung empedu, infeksi bakteri, trauma, pembedahanHarrisons Gastroenterology and Hepatology, 2e. 2013

DiagnosisDiagnosis kolesistitis biasanya ditegakkan berdasarkan anamnesis dan pemeriksaan fisik.Trias gejala kolesistitis antara lain nyeri bersifat akut di RUQ, demam dan leukositosisDemam biasanya ringan, tetapi jarang disertai menggigilBernafas dalam atau batuk saat dilakukan palpasi di RUQ biasanya menambah rasa nyeri dan nafas tertahan (Murphys sign)Pembesaran kantung empedu teraba pada 25-50% pasienKolik bilier, rasa nyeri tersebut dapat menyebar ke intraskapular, scapula kanan atau bahuTanda inflamasi peritoneal seperti nyeri seluruh abdomenBiasanya pasien mengalami anoreksia dan nausea. Harrisons Gastroenterology and Hepatology, 2e. 2013DiagnosisLeukocytosis, biasanya sekitar 10.000-15.000 dengan diftel shift to the left.Serum bilirubin, biasanya meningkat hingga 5 mg/dl pada hampir sebagian besar pasienUltrasound dapat menunjukkan kalkuli pada 90-95% kasusHarrisons Gastroenterology and Hepatology, 2e. 2013Differential DiagnoseManagementAlthough surgical intervention remains the mainstay of therapy for acute cholecystitis and its complications, a period of in-hospital stabilization may be required before cholecystectomy.Oral intake is eliminated, nasogastric suction may be indicated, and extracellular volume depletion and electrolyte abnormalities are repaired.Meperidine or nonsteroidal anti-inflammatory drugs (NSAIDs) are usually employed for analgesia.Intravenous antibiotic therapy is usually indicated in patients with severe acute cholecystitis.

Harrisons Gastroenterology and Hepatology, 2e. 2013ManagementThe optimal timing of surgical intervention in patients with acute cholecystitis depends on stabilization of the patient.Urgent (emergency) cholecystectomy or cholecystostomy is probably appropriate in most patients in whom a complication.Patients with uncomplicated acute cholecystitis should undergo early elective laparoscopic cholecystectomy, ideally within 72 hours after diagnosis.

Harrisons Gastroenterology and Hepatology, 2e. 2013Terima Kasih