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Similar a COLANGITIS COLECISTITIS.pptx
COLANGITIS COLECISTITIS.pptx
- 1. COLECISTITIS AGUDA Y COLANGITIS AGUDA DR.BRYAN RAFAEL GÁMEZ RESIDENTE DE CIRUGÍA ISSS
- 2. OBJETIVOS • Exponer lafisiopatología de la colangitis aguda y colecistitis aguda calculosa. • Enlistar los criterios diagnósticos de la colangitis aguda y colecistitis aguda • Describir los principios generales del tratamiento de la colangitis aguda y colecistitis aguda
- 3. COLECISTITIS AGUDA • Síndromede dolor en el cuadrante superior derecho, fiebre y leucocitosis asociado con inflamación de la vesícula biliar. • Se desarrolla en 6 a 11 % de pacientes con cálculos biliares sintomáticos .MORRIS CR, HOHF RP, IVY AC. Un estudio experimental del papel de la estasis en la etiología de la colecistitis. Cirugía 1952; 32:673.
- 4. FISIOPATOLOGÍA Roslyn JJ, DenBestenL, Thompson JE Jr, Silverman BF. Papeles de la bilis litogénica y la oclusión del conducto cístico en la patogenia de la colecistitis aguda. Am J Surg 1980; 140:126.
- 5. DIAGNÓSTICO 1. INFLAMACIÓN LOCAL •Signo de Murphy • Dolor, masa o molestia en HCD 2. INFLAMACIÓN SISTÉMICA • Fiebre • Leucocitosis • PCR >3.0mg/dL 3. HALLAZGOS RADIOLÓGICOS* Shea JA, Berlín JA, Escarce JJ, et al. Estimaciones revisadas de la sensibilidad y especificidad de las pruebas diagnósticas en la sospecha de enfermedad del tracto biliar. Arch Intern Med 1994; 154:2573.
- 6. Tokyo Guidelines 2018:flowchart for the management of acute cholecystitis
- 7. J Hepato BiliaryPancreat, Volume: 25, Issue: 1, Pages: 55-72, First published: 16 October 2017, jDOI: (10.1002/hbp.516) Grade I. λ, CCI 5 or less and/or ASA class II or less (low risk); µ, CCI 6 or greater and/or ASA class III or greater (not low risk) ALGORITMO DE MANEJO
- 8. ALGORITMO DE MANEJO JHepato Biliary Pancreat, Volume: 25, Issue: 1, Pages: 55-72, First published: 16 October 2017, DOI: (10.1002/jhbp.516) Grade II. α, antibiotics and general supportive care successful; ϕ, antibiotics and general supportive care fail to control inflammation; λ, CCI 5 or less and/or ASA-PS class II or less (low risk); µ, CCI 6 or greater and/or ASA-PS class III or greater (not low risk);
- 9. ALGORITMO DE MANEJO GradeIII. #, negative predictive factors: jaundice (TBil ≥2), neurological dysfunction, respiratory dysfunction; Φ, FOSF: favorable organ system failure = cardiovascular or renal organ system failure which is rapidly reversible after admission and before early LC in AC. in cases of Grade III, CCI (Charlson comorbidity index) 4 or greater, ASA-PS 3 or greater are high risk; J Hepato Biliary Pancreat, Volume: 25, Issue: 1, Pages: 55-72, First published: 16 October 2017, DOI: (10.1002/jhbp.516)
- 10. COLANGITIS “Es una infecciónde la vía biliar, potencialmente grave.” Jean Martin Charcot (1825—1893) Primera descripción en 1877 "Lección sobre las enfermedades del hígado, las vías biliares y los riñones" en la facultad de medicina de París A. Sokala, A. Sauvanetb, B. Fantin, V. de Lastoursa,c. 2019. Acute cholangitis: Diagnosis and management.
- 11. FISIOPATOLOGÍA Y ETIOLOGÍA 1.Obstrucción de la vía biliar Cálculos biliares (28-70%) 2. Proliferación bacteriana a) traslocación b) hematógena Singh A, Mann HS, Thukral CL, Singh NR. Diagnostic accuracy ofMRCP as compared to ultrasound/CT in patients with obstruc-tive jaundice. J Clin Diagn Res JCDR 2014;8:103—7. Panis Y, Fagniez PL, Brisset D, Lacaine F, Levard H, Hay JM. Longterm results of choledochoduodenostomy versus choledochoje- junostomy for choledocholithiasis. The French Association forSurgical Research. Surg Gynecol Obstet 1993;177:33—7.
- 12. MICROBIOLOGÍA Table 4 Micro-organisms cholangitis. responsiblefor acute Germ Hemoculture (%) Biliary cultures (%) Gram negative bacilli Escherichia coli 35—62 31—44 Klebsiella spp. 12—28 9—20 Pseudomonas spp. 4—14 0.5—19 Enterobacter spp. 2—7 5—9 Citrobacter spp. 2—6 Acinetobacter spp. 3 Gram-positive cocci Enterococcus spp. 10—23 3—34 Streptococcus spp. 6—9 2—10 Staphylococcus spp. 2 0 Anaerobia 1 4—20 Others 17 Adapted from Tokyo Guidelines 2018. Gomi H, Solomkin JS, Schlossberg D, et al. Tokyo Guidelines 2018: antimicrobial therapy for acute cholangitis and chole- cystitis. J Hepato- Biliary-Pancreat Sci 2018;25:3—16.
- 13. MANIFESTACIONES CLÍNICAS 80% 50-75% Nezman H.Afdhal, MD., Colangitis aguda: manifestaciones clínicas, diagnóstico y manejo. UptoDate. 2022.
- 14. DIAGNÓSTICO Tokyo Guidelines (TG) 2007-2013-2018 Sensibilidad92% Especificidad 78% Table 2 TG2013/2018 diagnostic criteria. Criteria Threshold A-Systemic inflammation A-1 Fever or chills > 38 ◦C A-2 Biological Leukocytes < 4 inflammatory or > 10G/L syndrome CRP≥10 mg/L B-Cholestasis B-1 Icterus/jaundice Total biliru- bin ≥ 34 µmol/L B-2 Abnormal liver ASAT, ALAT, function test PAL and gamma- GT > 1.5 × ULN C-Imagery C-1 Bile duct dilatation C-2 Imagery providing proof of etiology Suspected diagnosis One item in A + one item in B or C Certain diagnosis One item in A, B and C CRP: C reactive protein; ASAT: aspartate aminotransferase; ALAT: alanine aminotransferase; ULN: upper limit of normal. Yokoe M, Hata J, Takada T, et al. Tokyo Guidelines 2018: diag- nostic criteria and severity grading of acute cholecystitis (with videos). J Hepato-Biliary-Pancreat Sci 2018;25:41—54.
- 15. CRITERIOS DE GRAVEDAD Seasocian con un aumento de la mortalidad. Grado 1: 1,2 % Grado 2: 2,6 % Grado 3: más del 5 % Table 3 TG severity criteria 2013/2018. Grade Criteria Threshold Grade 3: Cardiovascular Dopamine > 5 µg/kg/ Severe dysfunction min or any dose of At least 1 noradrenalin criterium Neurological Consciousness dysfunction disorders Respiratory PaO2/FiO2 < 300 dysfunction Renal dysfunction Creatininuria > 176 µmol/L or oliguria Liver dysfunction INR > 1.5 Hematological Platelets < 100,000/ dysfunction mm3 Grade 2: Leucocytes < 4 G/L or > 12G/L Moderate At least 2 criteria Fever > 39 ◦C Age > 75 years Bilirubinemia 85 µmol/L Hypoalbuminemia < 0.7 × ILN Grade 1: Mild No criteria 2 or 3 PaO2: partial pressure of oxygen; FiO2: fraction of inspired oxygen; INR: International normalized ratio; ILN: inferior limit of the normal. Kiriyama S, Kozaka K, Takada T, et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos). J Hepato-Biliary-Pancreat Sci 2018;25:17—30.
- 16. TRATAMIENTO ANTIBIOTICOTERAPIA DRENAJE DELA VÍA BILIAR Solomkin JS, Mazuski JE, Bradley JS, et al. Diagnosis and mana- gement 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.
- 17. DRENAJE DE LAVÍA BILIAR Tres modalidades: Tratamiento quirúrgico: (hoy excepcional por su alta morbimortalidad en comparación con el tratamiento endoscópico). Drenaje endoscópico (CPRE o EE): Mediante la instalación de una prótesis metálica o plástica o una prótesis biliar, drenaje biliar Drenaje biliar transhepático percutáneo. Miura F, Okamoto K, Takada T, et al. Tokyo Guidelines 2018: initial management of acute biliary infection and flowchart for acute cholangitis. J Hepato-Biliary-Pancreat Sci 2018;25:31—40. Lai ECS, Mok FPT, Tan ESY, et al. Endoscopic biliary drainage for severe acute cholangitis. N Engl J Med 1992;326:1582—6.
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- 19. BIBLIOGRAFÍA • Kiriyama S,Kozaka K, Takada T, et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos). J Hepato-Biliary-Pancreat Sci 2018;25:17—30. • Lai ECS, Mok FPT, Tan ESY, et al. Endoscopic biliary drainage for severe acute cholangitis. N Engl J Med 1992;326:1582—6. • Miura F, Okamoto K, Takada T, et al. Tokyo Guidelines 2018: initial management of acute biliary infection and flowchart for acute cholangitis. J Hepato-Biliary-Pancreat Sci 2018;25:31—40. • MORRIS CR, HOHF RP, IVY AC. Un estudio experimental del papel de la estasis en la etiología de la colecistitis. Cirugía 1952; 32:673. • Roslyn JJ, DenBesten L, Thompson JE Jr, Silverman BF. Papeles de la bilis litogénica y la oclusión del conducto cístico en la patogenia de la colecistitis aguda. Am J Surg 1980; 140:126. • Shea JA, Berlín JA, Escarce JJ, et al. Estimaciones revisadas de la sensibilidad y especificidad de las pruebas diagnósticas en la sospecha de enfermedad del tracto biliar. Arch Intern Med 1994; 154:2573. • Solomkin JS, Mazuski JE, Bradley JS, et al. Diagnosis and mana- gement 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. • Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis • Yokoe M, Hata J, Takada T, et al. Tokyo Guidelines 2018: diag- nostic criteria and severity grading of acute cholecystitis (with videos). J Hepato-Biliary-Pancreat Sci 2018;25:41—54.
Notas del editor
- #8 TG18 flowchart for the management of acute cholecystitis Grade I. λ, CCI 5 or less and/or ASA class II or less (low risk); µ, CCI 6 or greater and/or ASA class III or greater (not low risk); ▵, in case of serious operative difficulty, bail‐out procedures including conversion should be used. ASA‐PS American Society of Anesthesiologists physical status. IF THIS IMAGE HAS BEEN PROVIDED BY OR IS OWNED BY A THIRD PARTY, AS INDICATED IN THE CAPTION LINE, THEN FURTHER PERMISSION MAY BE NEEDED BEFORE ANY FURTHER USE. PLEASE CONTACT WILEY'S PERMISSIONS DEPARTMENT ON PERMISSIONS@WILEY.COM OR USE THE RIGHTSLINK SERVICE BY CLICKING ON THE 'REQUEST PERMISSIONS' LINK ACCOMPANYING THIS ARTICLE. WILEY OR AUTHOR OWNED IMAGES MAY BE USED FOR NON-COMMERCIAL PURPOSES, SUBJECT TO PROPER CITATION OF THE ARTICLE, AUTHOR, AND PUBLISHER.