22. ACTITUD TERAPÉUTICA EN LA COLELITIASIS Colelitiasis Asintomática Sintomática Actitud expectante Vesícula en porcelana Disolución ideal (AUDC) Laparotomía por otra causa. Tratamiento Opcional Cálculos radiotransparentes Vesícula funcionante Colecistectomía laparoscopica Cálculos menores de 1 cm Cálculo único menor de 2 cm AUDC Litotricia extracorpórea
23.
24.
25.
26.
27.
28. COLECISTITIS AGUDA: DIAGNOSTICO Axial scan through the gallbladder shows marked thickening of the gallbladder wall, with the lumen of the gallbladder full of sludge. Oblique and longitudinal sonograms through gallbladder shows marked laminated sonolucent thickening of the gallbladder wall, sludge, and edema (arrow).
29.
30. COLECISTITIS AGUDA: DIAGNOSTICO Technetium-99m hepatic iminodiacetic acid ( 99m Tc-HIDA) scan followed for 1 hour 30 minutes shows no filling of the gallbladder due to cystic duct obstruction.
31. COLECISTITIS AGUDA: DIAGNOSTICO Acute emphysematous cholecystitis. Color Doppler images of the gallbladder of an 82-year-old male with diabetes mellitus who presented with abdominal distention and vomiting. Ultrasound shows a markedly thickened gallbladder wall, which is hypervascularized. There are no gallstones, but note the presence of air in the anterior wall of the gallbladder CT scan shows pearl gallstones and thickening of the gallbladder wall.
37. DIAGNOSTICO This 84 year-old man presented with jaundice and epigastric pain. Several biliary calculi are shown within the dilated distal common bile duct on this abdominal ultrasound. ERCP showing a bile duct stone in a patient who has had a previous laparoscopic cholecystectomy.
38. DIAGNOSTICO Colangiografía por resonancia magnética (C-RM), donde se aprecia coledocolitiasis múltiple. (CPRE) con cálculo en el conducto cístico.
39.
40. TRATAMIENTO: ENDOPROTESIS A, B, C Dilatación endoscópica de estenosis postoperatoria de la vía biliar, con colocación de múltiples prótesis plásticas. D. Resultado final a los 9 meses .