COLECISTITIS AGUDAMartnez vila, Aldrin EduardoInterno Medicina HCLLHServicio de Medicina

DEFINICINLa colecistitis aguda es una enfermedad inflamatoria aguda de la vescula biliar.

A menudo es atribuible a los clculos biliares.

Varios factores.* Kimura Y, Takada T, Kawarada Y. Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg. 2007; 14:15-26.

INCIDENCIALos casos agudos colecistitis representan el 3% y el 10% de los pacientes con dolor abdominal. * Kimura Y, Takada T, Kawarada Y. Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg. 2007; 14:15-26.

ETIOLOGAClsicamente resumido fx. Como 4F:

FemaleFatFertileForty

Tendencia M>VObesidad: M: IMC >34V: IMC >38Niveles ProgesteronaColelitiasis(90-95%)Medicamentos asociados

ETIOLOGAAscarisEmbarazo: Implicados estrgenos y progesterona CBColecistitis 2da. causa abdomen agudoColelitiasis causa + frecuente de colecistitis en el embarazo.No se sabe si el embarazo riesgo colecistitis.FISIOPATOLOGA* Kimura Y, Takada T, Kawarada Y. Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg. 2007; 14:15-26.

2 Factores : Grado de obstruccin + Duracin obstruccin

FISIOPATOLOGAstasis secundaria a ObstruccinMedio ambiente ideal para crecimiento bacterianoEscherichia coliKlebsiella pneumoniaeEnterobacter spp.Bacteroides fragilisClostridium spp.Fusobacterium spp..Enterococcus spp.Streptococcus faecalisInfeccin bacteriana es secundaria y que complica en 50% casos.

CLASIFICACIN PATOLGICA* Kimura Y, Takada T, Kawarada Y. Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg. 2007; 14:15-26.

* Kimura Y, Takada T, Kawarada Y. Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg. 2007; 14:15-26.

COMPLICACIONESPerforacin vescula biliar ( CA, tumores x Isquemia o necrosis de pared vesicular).Peritonitis biliarAbsceso pericolecsticoFstula biliarPRONSTICORIP pacientes CA 0 10%CA post-operatorio y CA alitisica 23-40%Adultos >75Comorbilidad

Actualemente: Tumores malignos,Insuf. Respiratoria, IC.

CUADRO CLNICODolor (>6h), Nausea y vmitos, Anorexia.FiebreDolor en HCDSigno de Murphy (S: 97%, E: 48%)Vescula palpable en (1/3pac)DeshidratacinIrritacin peritoneal localizada, distensinRHA

Examen Fsico:Dolor intensoSIRSTaquipnea y deshidratacinVescula palpableGeritricos: Clnica + Ex. Aux.Signo Boas: Dolor a la derecha vrtebra T10-T12, S: 7%.

DIAGNSTICO * Hirota M, Takada T, Kawarada Y, Nimura Y, Miura F, Hirata K, et al. Diagnostic criteria and severity assessment of acute cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg. 2007;14:78-82.

S: 97%, E: 76% * Hirota M, Takada T, Kawarada Y, Nimura Y, Miura F, Hirata K, et al. Diagnostic criteria and severity assessment of acute cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg. 2007;14:78-82.

S: 97%, E: 87% * Hirota M, Takada T, Kawarada Y, Nimura Y, Miura F, Hirata K, et al. Diagnostic criteria and severity assessment of acute cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg. 2007;14:78-82.

DIAGNSTICOS DIFERENCIALESPerforacin de lcera ppticaInfarto de miocardioPancreatitisHernia hiatalNeumona basal derechaApendicitisHepatitis

CRITERIOS DE SEVERIDAD EN COLECISTITIS AGUDA * Hirota M, Takada T, Kawarada Y, Nimura Y, Miura F, Hirata K, et al. Diagnostic criteria and severity assessment of acute cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg. 2007;14:78-82.

CRITERIOS DE SEVERIDAD EN COLECISTITIS AGUDA * Hirota M, Takada T, Kawarada Y, Nimura Y, Miura F, Hirata K, et al. Diagnostic criteria and severity assessment of acute cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg. 2007;14:78-82.

CRITERIOS DE SEVERIDAD EN COLECISTITIS AGUDA * Hirota M, Takada T, Kawarada Y, Nimura Y, Miura F, Hirata K, et al. Diagnostic criteria and severity assessment of acute cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg. 2007;14:78-82.

TRATAMIENTOSuspender VO.

Corregir alteraciones hidroelectroliticas.

Iniciar Analgesia y antibiticos.

El tto. mdico-Qx. Depender de la gravedad de la enfermedad.

*Akriviadis EA, Hatzigavriel M, Kapnias D, Kirimlidis J, Markantas A, Garyfallos A. Treatment of biliary colic with diclofenac: a randomized, doubleblind, placebo-controlled study. Gastroenterology. 1997;113:225-31.

* Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJC, Baron EJ, et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: Guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis. 2010;50:133-64.