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Samenvatting Pathologie
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Abdominale heelkunde 4Cholelithiase
= galstenen
- Cholesterolstenen:
● Radiolucent (oplosbaar)
● Verkalkt (onoplosbaar)
- Pigmentstenen (onoplosbaar):
● Bilirubinaat zwart: hemolyse
● Slijk (sludge) bruin: primaire CDL
- Verwikkelingen:
● Van CCL (cholecystolithiase):
Eerst crise, daarna cholecystitis
Fistel naar galwegen (= mirizzi)
Galblaaskanker
CDL
● Van CDL (choledocho-lithiasis):
Pijnlijke icterus (gele sclerae, ontkleurde stoelgang, donkere urine, gele huidskleur)
Cholangitis, sepsis, leverabces
Pancreatitis
Cholecystolithiase
= galblaasstenen
- Asymptomatisch:
● 20% wordt symptomatisch
● Koliek (crise) is altijd eerste symptoom
→ geen cholecystectomie (galblaas verwijdering)
- Symptomatisch:
● Blijft symptomatisch
● Groot risico voor verwikkelingen
→ Electieve laparoscopische cholecystectomie bij typische symptomen (bv bij neuro
endocriene darm)
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, - Regel van “F”:
● Female
● Fair (blond)
● Fertile (na zwangerschap of na obesitas operatie)
● Fat
● Forty
- Symptomen:
● Asymptomatisch:
Toevallige vondst (door echo)
● Typisch = galkoliek (crise) na maaltijd (post-prandiaal/vesperaal)
● Atypisch:
Vage bovenbuiklast
● Verwikkeld
- Behandeling:
● Laparoscopische cholecystectomie → pre-operatief RX cholangio (voor choledocho-
lithiase en anatomie)
Laparoscopische cholecystectomie:
- Mortaliteit = 0
- Morbiditeit:
● Bloeding
● Icterus (geelzucht)
● Infectie (wonde, subhepatisch)
● Gallek (cystitus,…)
Complicaties van galblaasstenen:
- Obstructie thv de ductus cysticus:
● Hydrops
● Acute cholecystitis
- Obstructie thv de ductus choledochus:
● Obstructieve icterus
● Cholangitis
- Obstructie thd de papil van Vater:
● Pancreatitis
Hydrops:
- Galvloeistof stapelt zich op
- Gaat meestal spontaan weg
- Symptomen:
● Koliek → continue pijn → peervormige massa
- Geen of beperkt effect van Buscopan
- Echo doen
- Evolutie:
● Verdwijnen van de hydrops
● Acute pericitis → empyeem → perforatie → Mirizzi
- Behandeling:
● Dringende laparoscopische cholecystectomie (< 72u)
119
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