COLECISTITIS AGUDA

Martnez vila, Aldrin Eduardo

Interno Medicina HCLLH
Servicio de Medicina
DEFINICIN
La 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.
INCIDENCIA
Los 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.
ETIOLOGA
Clsicamente resumido
fx. Como 4F:

Female
Fat
Fertile
Forty

Tendencia M>V
Obesidad:
M: IMC >34
V: IMC >38
Niveles
Progesterona
Colelitiasis
(90-95%)
Medicamentos asociados
ETIOLOGA
Ascaris
Embarazo: Implicados estrgenos y progesterona CB
Colecistitis 2da. causa abdomen agudo
Colelitiasis 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
FISIOPATOLOGA
stasis secundaria a Obstruccin
Medio ambiente ideal para crecimiento bacteriano
Escherichia coli
Klebsiella pneumoniae
Enterobacter spp.
Bacteroides fragilis
Clostridium spp.
Fusobacterium spp..
Enterococcus spp.
Streptococcus faecalis
Infeccin 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.
COMPLICACIONES
1. Perforacin vescula biliar ( CA, tumores x Isquemia o
necrosis de pared vesicular).
2. Peritonitis biliar
3. Absceso pericolecstico
4. Fstula biliar
PRONSTICO
RIP
pacientes CA 0 10%
CA post-operatorio y CA alitisica 23-40%
Adultos >75
Comorbilidad
Actualemente: Tumores malignos,
Insuf. Respiratoria, IC.
CUADRO CLNICO
Dolor (>6h),
Nausea y vmitos, Anorexia.
Fiebre
Dolor en HCD
Signo de Murphy (S: 97%,
E: 48%)
Vescula palpable en (1/3pac)
Deshidratacin
Irritacin peritoneal
localizada, distensin
RHA

Examen Fsico:
Dolor intenso
SIRS
Taquipnea y deshidratacin
Vescula palpable
Geritricos: 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 DIFERENCIALES
Perforacin de lcera
pptica
Infarto de miocardio
Pancreatitis
Hernia hiatal
Neumona basal
derecha
Apendicitis
Hepatitis


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.
TRATAMIENTO
Suspender 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.