Anterior aspect of the biliary anatomy. a = right hepatic duct; b = left hepatic duct; c = common hepatic duct; d = portal vein; e = hepatic artery; f = gastroduodenal artery; g = left gastric artery; h = common bile duct; i = fundus of the gallbladder; j = body of gallbladder; k = infundibulum; l = cystic duct; m = cystic artery; n = superior pancreaticoduodenal artery. Note: the situation of the hepatic bile duct confluence anterior to the right branch of the portal vein, the posterior course of the right hepatic artery behind the common hepatic duct.

The effect of cholecystokinin on the gallbladder and the sphincter of Oddi. A. During fasting, with the sphincter of Oddi contracted and the gallbladder filling. B. In response to a meal, the sphincter of Oddi relaxed and the gallbladder emptying.

AAA, abdominal aortic aneurysm.

Surgery at a Glance 2nd Ed, 2002

Emergency Surgery, Adam Brooks, 2010

Case File Surgery, 3th Ed, 2009

Gallstones 5Fs

Fat, female., fair, fertile, forty

Equilibrium phase diagram for bile salt “lecithin“cholesterol“water at a concentration of 10% solids, 90% water. The monomeric phase is not depicted as a phase because it exists at the same concentration throughout. The one-phase zone contains only micelles. Several other zones exist, but only the two on the left above the one-phase zone apply to human gallbladder bile, and both contain cholesterol monohydrate crystals at equilibrium.

Scheme showing pathogenesis of cholesterol gallstone formation. Conditions or factors that increase the ratio of cholesterol to bile acids and phospholipids (lecithin) favor gallstone formation. HMG-CoAR, hydroxymethylglutaryl–coenzyme A reductase; 7--OHase, cholesterol, 7-hydroxylase; MDR3, multidrug resistance–associated protein 3, also called phospholipid export pump

Floating gallstones. A: Sagittal scan. B: Transverse scan. Scans show multiple hyperechoic structures (arrowheads) floating in the lumen of the gallbladder

A

B

80% of gallstones are cholesterol stones and about 15 to 20% are black pigment stones

(A) Cholesterol gallstones. (B) Black pigment gallstones. (C) Brown pigment gallstone.

90-95% kolesisititis akut disertai batu empeduKolesistitis akut tanpa batu empedu: jarang

Batu empedu obstruksi DistensiEdema

InflamasiKholesistitis akutPerforasi

Peritonitiskontamin

asi

Gambaran Klinis

• Nyeri kolik bilier yg tidak berkurang bertambah nyeri• Demam, anoreksia, nausea dan vomitus• Nyeri bertambah bila bergerak• Nyeri tekan dan nyeri lepas perut kanan atas• Murphy’s sign• Lekositosis 12.000 – 15.000 /mm3

• Bilirubin, alkali fosfatase, transaminase dan amilase meningkat • Ikterus

Acute Cholecystitis

2/3 batu empedu kolesistitis kronis

Gambaran klinis

• Nyeri : konstan, hilang bbp jam (5 jam)• Lokasi epigastrium, perut kanan atas, menjalar ke punggung / skapula• Datang tiba-2 ssdh makan (lemak)• Disertai nausea dan vomitus• Nyeri tekan perut kanan atas, nyeri lepas (-)• Sering diagnosis keliru dengan gastritis, (maag) diberi obat maag.