ves biliar, colecistitis, colelitiasis
DESCRIPTION
Colecistitis y colelitiasis Presentación por: Dr. Luis Humberto Cruz ContrerasTRANSCRIPT
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Vesícula biliar, colecistitis y colelitiasisDr. Luis Humberto Cruz ContrerasHospital General “Dr. Miguel Silva”Morelia, Michoacán
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Colelitiasis
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Colelitiasis
• Colesterol• supersaturación
• Pigmento biliar• hemolisis crónica• infecciones
Litos
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Epidemiología USA
Enfermedad digestiva más cara
700,000 colecistectomías anuales
20 millones de personas
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Factores de riesgo4 F
Obesidad
Hormonales
Edad avanzada
Multiparidad
Hiperlipidemia
Errores innatos del metabolismo
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PatogénesisLitos colesterol
Supersaturación colesterol
Sobrecupo - Ácidos biliares
Colesterol libre - hipomotilidad
Nucleación de cristales
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Patogénesis litos pigmento
Bilirubinato calcio
• Café y Negro
Niveles de bilirubina NO conjugada
Infecciones bacterianas
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Cuadro clínico
ASINTOMÁTICOS (2/3)
Cólico biliar
• Cólico CSD• Irradia a espalda y hombro• Después de comer• Obstrucción intermitente del conducto cístico
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ComplicacionesIctericia obstructiva
Pancreatitis
Colangitis
Perforación de la vesícula biliar
Formación de fístulas
Ileo biliar
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PatologíaColesterol• Múltiples• Redondas -
ovoideas• Facetadas• < 2 cm diámetro
Pigmento biliar• Pequeñas• Blandas• Espiculadas
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Patología«Casi» Normal
Inflamación aguda
Inflamación crónica
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Colecistitis aguda
Cólico biliar Fiebre
Leucocitosis
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Colecistitis agudaLitos 95% de los casos
50% inf. bacteriana secundaria
• E. Coli
Colecistits acalculosa
• Ancianos, isquemia, trauma, sepsis
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Patología
Macro
• Distensión, edema, congestión, erosión de mucosa
Micro
• Neutrófilos en la pared y mucosa
Otras formas
• Gangrenosa, enfisematosa, empiema (piocolecisto)
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Fibroblastos activados y edema en adventicia
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Colecistitis crónicaPresentación clínica similarPatología
Criterios mal definidos Inflamación crónicaFibrosisSenos Aschoff-Rokitansky
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Otras formas de colecistitsXantogranulomatosa
Vesícula en porcelana
• > Riesgo carcinoma
Eosinofílica
• Asoc. Parásitos, atopia, te herbal
Asociada a colangitis esclerosante primaria
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Colesterolosis
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Colesterolosis
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Colecistits eosinofílica
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Colecistitis xantogranulomatosa
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RinoescleromaEnfermedad
inflamatoria de la nariz causada por
bacterias del grupo Klebsiella
Micro, Macrófagos espumosos (cél. Mikulicz) y cel.
plasmáticas
Vasculitis, hiperplasia
pseudoepiteliomatosa, vasculitis
Warthin-Starry, PAS
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rinoscleroma
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rinoscleroma
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rinoscleroma
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Rinoescleroma – Etapas clínicas
3. Esclerótico
2. Granulomato
so
1. Catarr
al
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rinoscleroma
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rinoscleroma
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rinoscleroma
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Tinción Whartin-Starry