Cholelitiasis a.k.a. gall stones are crystalline deposits that occur in the gall bladder. If gallstones are found in the bile ducts called choledocolitiasis.
"Early detection of Cholelitiasis disorders is very important in order not to interfere with quality of life of patients, and this can be done through the liver function tests, ultrasound and CT scans. Even with a more sophisticated device, the most accurate diagnosis for gallbladder inflammation (acute cholecystitis) may be obtained from the examination skintigrafi hepatobilier, which gives a picture of the liver, bile duct, gall bladder and the upper small intestine ", expressed by Dr. Tjahyono Sigit, who is also as Chief of Medical Committee, Puri Indah Hospital, Jakarta.
Generally there are 3 kinds of rocks that may occur, namely:
1. Cholesterol stones, which occurs when bile contains large amounts of cholesterol that usually remains as a liquid. When bile becomes saturated cholesterol, the cholesterol becomes insoluble and forms deposits. This case reaches 80 percent of cases of gallstone disease.
2. Bilirubin stone, occurs when unconjugated bilirubin consentration increased. Bilirubin has a tendency to bind with calcium, forming insoluble precipitates. With increasing concentration of bilirubin, calcium bilirubinate can crystallize and form stones. Over time, various types of oxidation that occurs resulting precipitate bilirubin. Because of its color, this stone is known as a black stone.
3. Mix Stone, a mixture of both types of stone above tesebut.
To be aware of this disease can be used benchmark 4F:
• Women (Female) although men also was not susceptible to this disorder, because the pattern of unhealthy eating can also be a cholelitiasis trigger factor.
• Age 40 years (Forty)
• High-fat diet (Fatty)
• Still active in the reproductive (Fertile)
Basically, this disease does not need to worry and unnecessary medical treatment for does not cause pain or discomfort such as a particular pain. But to know the early symptoms of deterioration are usually cholelitiasis will feel the symptoms:
• Pain in the upper right abdomen, sometimes like being blackmailed and intermittent, spread to the back right shoulder. May occur several minutes to several hours.
• Fever
• Nausea
• Vomiting
• Yellow (ikterik)
To determine whether a person has to be done cholelitiasis medical examination, because sometimes patients feel just like ulcer symptoms alone. Supporting examination to detect gallstones done by inspection:
1. Heart function tests
2. In gallbladder stones, generally Gamma GT and Alkaline Phosphatase increased.
3. USG Abdomen
4. Visible image of the gall-bladder stones, and sometimes can be seen in the bile ducts.
5. Other tests such as CT scans if the Abdomen ultrasound can not describe it clearly.
If you have entered a stage of acute (Acute cholecystitis) there will be inflammation of the gallbladder wall, usually the result of gallstones in cystic duct, which causes sudden attacks of great pain.
Approximately 95% of those with acute gallbladder inflammation, have gallstones. Sometimes, the inflammation that occurs is caused by bacterial infection. Before you feel the incredible pain in the upper abdomen of a sudden, the patient usually does not show signs of gallbladder disease.
While acute cholecystitis without stones (5%) is a serious illness and tends to occur after the occurrence:
• Injuries resulting from a hematoma, etc..
• Infections caused by burns
• Sepsis (infection that spreads throughout the body)
The influence of infection from diseases severe (especially people who receive food intravenously in a long time). Acute gallstone symptoms include:
• Pain in upper right abdomen, intensified when the patient take a deep breath and often spread to the right shoulder.
• Nausea
• Vomiting
• Low-grade fever, the longer it tends to rise.
• Usually less pain attacks within 2-3 days and then disappeared within 1 week.
In the event of complications, it will happen
• High fever, chills, increased number of leukocytes and the cessation of bowel movements (ileus) may indicate the occurrence of abscesses, gangrenous or perforated gallbladder.
• The attack is accompanied by jaundice (yellow fever), or backflow of bile into the liver suggests that bile duct has been blocked in part by gallstones or by inflammation.
• If blood tests show elevated levels of amylase enzyme, may have occurred inflammation of the pancreas (pancreatitis) caused by gallstone obstruction of pancreatic duct (pancreatic duct)
For the treatment of the patient will be required to be hospitalized and given intravenous fluids and electrolytes and is not allowed to eat or drink.
Likely the doctor will put the pipe to keep nasogastric remained empty stomach so that the stimulation of the gall bladder can be reduced. If suspected acute cholecystitis, the patient will be given antibiotics as soon as possible.
If the diagnosis is certain and the stakes are small, usually surgery to remove the gall bladder will be done on the first day or two since the patients treated. If patients suffering from other diseases that can increase the risk of surgery, the surgery will be postponed until the treatment of these illnesses are going well. If the attack subsided, gall bladder can be removed at least 6 weeks later. But if there are complications (eg abscesses, gangrene or perforation of the gall bladder), surgery should be done immediately.
If not found symptoms, it usually does not require treatment, only require dietary changes. But when gallstones are causing recurrent pain attacks despite a diet is set up properly, patients are encouraged to undergo gall bladder removal (cholesystektomi).
Cholesistektomi can be done in a conventional or laparoscopic. Since laparoscopic dipekenalkan in 1990, then laparoscopic cholecystectomy began much done and now about 90% done in laparoscopic cholecystectomy.
Laparoscopic cholecystectomy is raised gallbladder surgery through the tube inserted through a small incision in the abdominal wall. This type of surgery has the following advantages:
• reduces discomfort after surgery
• shorten the period of hospitalization.
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