Tugas KMB III
KOLELITIASIs
Oleh: Kelompok 6 1. Aulia Dwi Zukmana
(06060012)
2. Endah Setyo rini
(06060012)
3. Anis Khiliya
(06060018)
4. Rahma Latifa
(06060024)
5. Yufi Febri Hadi
(06060030)
6. Wahyu Saputro
(06060038)
Program Studi Ilmu Keperawatan Fakultas Ilmu Kesehatan UNIVERSITAS MUHAMMADIYAH MUHAMMADIYAH MALANG MAL ANG 2009 BAB I
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PENDAHULUAN
1.1 Latar Belakang Insiden kolelitiasis atau batu kandung empedu di Amerika Serikat diperkirakan 20 juta orang yaitu 5 juta pria dan 15 juta wanita. Pada pemeriksaan autopsy di Amerika, batu kandung empedu ditemukan pada 20 % wanita dan 8 % pria. Insiden batu kandung empedu di Indonesia belum diketahui dengan pasti, karena belu belum m ada ada pene peneli liti tian. an. Bany Banyak ak pend penderi erita ta batu batu kandu kandung ng empe empedu du tanpa tanpa geja gejala la dan dan ditemukan secara kebetulan pada waktu dilakukan foto polos abdomen, USG, atau saat operasi untuk tujuan yang lain. Dengan perkembangan peralatan dan teknik diagnosis yang baru USG, maka banyak penderita batu kandung empedu yang ditemukan secara dini sehingga dapat dicegah kemungkinan terjadinya komplikasi. Semakin canggihnya peralatan dan semakin kurang invasifnya tindakan pengobatan sangat mengurangi morbiditas dan moralitas. Batu kandung empedu biasanya baru menimbulkan gejala dan keluhan bila batu menyumbat duktus sistikus atau duktus koledokus. Oleh karena itu gambaran klinis penderita batu kandung empedu bervariasi dari yang berat atau jelas sampai yang ringan atau samar bahkan seringkali tanpa gejala (silent stone).
1.2 Tujuan 1.2.1
Tujuan Umum
Untuk Untuk menget mengetahui ahui dan memaham memahamii lebih lebih dalam dalam lagi lagi yang yang dimaks dimaksud ud dengan dengan kolelitiasis.
1.2.2
Tujuan Khusus
a) Unt Untuk
meng menget etah ahui ui
dan dan
mem memaham ahamii
defi defini nisi si,,
epi epidemi demiol olog ogii,
eti etiolog ologii,
pato patogen genes esis is,, gamb gambara aran n klini klinis, s, diag diagnos nosis is,, penat penatal alaks aksana anaan an dan dan Asuh Asuhan an keperawatan pada Kolelitiasis.
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PEMBAHASAN
2.1 Defenisi
Cholel Cho lelit ithias hiasis is mer merupak upakan an ada adanya nya ata atau u pem pembent bentukan ukan bat batu u emp empedu edu;; bat batu u ini mungki mun gkin n ter terdapa dapatt dal dalam am kan kandung dung emp empedu edu (ch (chole olecys cystol tolith ithias iasis) is) ata atau u dal dalam am duct ductus us choledochus (choledocholithiasis). Kolelitiasi Kolelitiasiss (kalkuli/ka (kalkuli/kalkulu lkulus, s, batu empedu) empedu) merupakan merupakan suatu keadaan dimana terdapa terdapatny tnyaa batu batu empedu empedu di dalam dalam kandung kandung empedu empedu (vesic (vesicaa fellea fellea)) yang yang memili memiliki ki ukuran,bentuk dan komposisi yang bervariasi. Kolelitiasis lebih sering dijumpai pada indivi individu du berusi berusiaa diatas diatas 40 tahun tahun terutam terutamaa pada wanita wanita dikare dikarenaka nakan n memili memiliki ki faktor faktor resiko,yaitu: obesitas, usia lanjut, diet tinggi lemak dan genetik. Sinonimnya adalah batu empedu, g allstones allstones , , biliary calculus. Istilah kolelitiasis dimaksudkan untuk pembentukan batu di dalam kandung empedu. Batu kandung empedu merupakan gabungan beberapa unsur yang membentuk suatu material mirip batu yang terbentuk di dalam kandung empedu.
Gambar 1: Batu dalam kandung empedu.
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2.2 Anatomi
Kandung Kandung empedu empedu (Vesic (Vesicaa fellea fellea)) adalah adalah kantong kantong berbent berbentuk uk buah buah pear yang terletak pada permukaan visceral hepar, panjangnya sekitar 7 – 10 cm. Kapasitasnya sekitar 30-50 cc dan dalam keadaan terobstruksi dapat menggembung sampai 300 cc. Vesica fellea dibagi menjadi fundus, corpus dan collum. Fundus berbentuk bulat dan biasanya biasanya menonjol menonjol dibawah dibawah pinggir pinggir inferior inferior hepar yang dimana fundus berhubungan berhubungan denga dengan n dind dindin ing g anter anterio iorr abdo abdome men n seti setingg nggii ujung ujung rawa rawan n cost costaa IX kanan kanan.. Corp Corpus us bersen bersentuh tuhan an dengan dengan permuk permukaan aan viscer visceral al hati hati dan arahny arahnyaa keatas keatas,, belakan belakang g dan kiri. kiri. Collum dilanjutkan dilanjutkan sebagai duktus cysticus cysticus yang berjalan berjalan dalam omentum omentum minus untuk bersat bersatu u dengan dengan sisi sisi kanan kanan ductus ductus hepati hepaticus cus comuni comuniss membent membentuk uk duktus duktus koledok koledokus. us. Peritoneum mengelilingi fundus vesica fellea dengan sempurna menghubungkan corpus dan collum dengan permukaan visceral hati. Pembuluh arteri kandung empedu adalah arteri cystica, cabang arteri hepatica kanan. Vena cystica mengalirkan darah lengsung kedalam vena porta. Sejumlah arteri yang sangat kecil dan vena – vena juga berjalan antara hati dan kandung empedu. Pembuluh limfe berjalan menuju ke nodi lymphatici cysticae yang terletak dekat collum collum vesica vesica fellea fellea.. Dari Dari sini, sini, pembul pembuluh uh limfe limfe berjal berjalan an melalu melaluii nodi nodi lymphat lymphatici ici hepaticum sepanjang perjalanan arteri hepatica menuju ke nodi lymphatici coeliacus. Saraf yang menuju kekandung empedu berasal dari plexus coeliacus.
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2.3 Fisiologi Saluran Empedu
Vesica fellea berperan sebagai resevoir empedu dengan kapasitas sekitar 50 ml. Vesica fellea mempunya kemampuan memekatkan empedu. Dan untuk membantu proses ini, ini, mukos mukosany anyaa memp mempun unya yaii lipat lipatan an-l -lip ipat atan an perm perman anen en yang yang satu satu sama sama lain lain sali saling ng berhubungan. Sehingga permukaanya tampak seperti sarang tawon. Sel- sel thorak yang membatasinya juga mempunyai banyak mikrovilli. Empedu Empedu dibent dibentuk uk oleh oleh sel-se sel-sell hati hati ditamp ditampung ung di dalam dalam kanali kanalikul kuli. i. Kemudi Kemudian an disalu disalurka rkan n ke duktus duktus biliar biliaris is termi terminal nalis is yang yang terlet terletak ak di dalam dalam septum septum interl interloba obaris ris.. Saluran ini kemudian keluar dari hati sebagai duktus hepatikus kanan dan kiri. Kemudian keduany keduanyaa membent membentuk uk duktus duktus biliar biliaris is komuni komunis. s. Pada Pada salura saluran n ini sebelu sebelum m mencap mencapai ai doudenum terdapat cabang ke kandung empedu yaitu duktus sistikus yang berfungsi sebagai tempat penyimpanan empedu sebelum disalurkan ke duodenum.
Gambar 3: Posisi anatomis dari vesica fellea dan organ sekitarnya.
Pengosongan Kandung Empedu
Empedu dialirkan dialirkan sebagai sebagai akibat kontraksi kontraksi dan pengosongan pengosongan parsial kandung empedu. Mekanisme ini diawali dengan masuknya makanan berlemak kedalam duodenum. Lemak menyebabkan pengeluaran hormon kolesistokinin dari mukosa
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empedu yang kental ke dalam duodenum. Garam – garam empedu dalam cairan empedu empedu penting penting untuk untuk emulsi emulsifi fikas kasii lemak lemak dalam dalam usus usus halus halus dan memban membantu tu pencernaan dan absorbsi lemak. Proses koordinasi kedua aktifitas ini disebabkan oleh dua hal yaitu: a) Hormonal: Hormonal: Zat lemak yang yang terdapat terdapat pada pada makanan makanan setelah setelah sampai sampai duodenum duodenum akan merangsang mukosa sehingga hormon Cholecystokinin akan terlepas. Hormon ini yang paling besar peranannya dalam kontraksi kandung empedu. b) b) Neur Neurog ogen en:: Stimulasi asi vagal vagal yang yang berhubu berhubunga ngan n dengan dengan fase fase Cephal Cephalik ik dari dari sekres sekresii Stimul cairan lambung atau dengan refleks intestino-intestinal akan menyebabkan kontraksi dari kandung empedu. Rangsangan langsung dari makanan yang masuk sampai ke duodenum dan
meng mengen enai ai Sphi Sphinc ncte terr Oddi Oddi.. Sehi Sehing ngga ga pada pada keada keadaan an dima dimana na kandu kandung ng empedu lumpuh, cairan empedu akan tetap keluar walaupun sedikit.
Pengosongan empedu yang lambat akibat gangguan neurologis maupun hormonal memegang peran penting dalam perkembangan inti batu.
Komposisi Cairan Empedu Komponen
Dari Hati
Dari Kandung Empedu
Air
97,5
gm %
95
gm %
Garam Empedu
1 ,1
gm %
6
gm %
Bilirubin
0,04
gm %
0 ,3
gm %
Kolesterol
0,1
gm %
0,3 – 0,9
gm %
Asam Lemak
0,12
gm %
0,3 – 1,2
gm %
Lecithin
0,04
gm %
0 ,3
gm %
Elektrolit
-
-
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Asam empedu berasal dari kolesterol. Asam empedu dari hati ada dua macam yaitu : Asam Deoxycholat dan Asam Cholat. Fungsi garam empedu adalah: o
Menuru Menurunkan nkan teganga tegangan n permuk permukaan aan dari dari parti partikel kel lemak lemak yang yang terdapa terdapatt dalam dalam makanan makanan,, sehing sehingga ga partik partikel el lemak lemak yang yang besar besar dapat dapat dipeca dipecah h menjadi partikel-partikel kecil untuk dapat dicerna lebih lanjut.
o
Membantu absorbsi asam lemak, monoglycerid, kolesterol dan vitamin yang larut dalam lemak.
Garam empedu yang masuk ke dalam lumen usus oleh kerja kuman-kuman usus dirubah menjadi deoxycholat dan lithocholat. Sebagian besar (90 %) garam empedu dalam lumen usus akan diabsorbsi kembali oleh mukosa usus sedangkan sisanya akan dikeluarkan bersama feses dalam bentuk lithocholat. Absorbsi garam empedu tersebut terjadi disegmen distal dari ilium. Sehingga bila ada gangguan pada daerah tersebut misalnya oleh karena radang atau reseksi maka absorbsi garam empedu akan terganggu. b. Bili Biliru rubi bin n Hemoglobin yang terlepas dari eritrosit akan pecah menjadi heme dan globin. Heme bersatu membentuk rantai dengan empat inti pyrole menjadi bilverdin yang segera berubah menjadi bilirubin bebas. Zat ini di dalam plasma terikat erat oleh albumin. Sebagian bilirubin bebas diikat oleh zat lain (konjugasi) yait yaitu u 80% 80% oleh oleh gluk glukur uron onid ide. e. Bila Bila terj terjad adii peme pemecah cahan an sel sel dara darah h mera merah h berleb berlebiha ihan n misal misalnya nya pada malari malariaa maka maka bilir bilirubi ubin n yang yang terben terbentuk tuk sangat sangat
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Berwarna coklat atau coklat tua, lunak, mudah dihancurkan dan mengandung kalsium-bilirubinat sebagai komponen utama. c) Ba Batu tu pi pigm gmen en hi hita tam m Berwarna hitam atau hitam kecoklatan, tidak berbentuk, seperti bubuk dan kaya akan sisa zat hitam yang tak terekstraksi.
2.5 Epidemiologi
Insiden kolelitiasis di negara barat adalah 20% dan banyak menyerang orang dewasa dan usia lanjut. Angka kejadian di Indonesia di duga tidak berbeda jauh dengan angka di negara lain di Asia Tenggara dan sejak tahu 1980-an agaknya berkaitan erat dengan cara diagnosis dengan ultrasonografi.
2.6 Etiologi/Faktor Resiko
Kolelitiasis dapat terjadi dengan atau tanpa faktor resiko dibawah ini. Namun, semaki sem akin n ban banyak yak fak faktor tor res resiko iko yan yang g dim dimili iliki ki ses seseor eorang ang,, sem semaki akin n bes besar ar kem kemungk ungkina inan n untuk terjadinya kolelitiasis. Faktor resiko tersebut antara lain: a. Jen eniis Ke Kellam amiin Wanita mempunyai resiko 3 kali lipat untuk terkena kolelitiasis dibandingkan dengan den gan pri pria. a. Ini dik dikare arenaka nakan n ole oleh h hor hormon mon est estero erogen gen ber berpen pengar garuh uh ter terhad hadap ap pen penin ingk gkat atan an es eskr kres esii ko kole lest ster erol ol ol oleh eh ka kandu ndung ng em emped pedu. u. Ke Keha hami mila lan, n, ya yang ng menigk men igkatka atkan n kad kadar ar est estero erogen gen jug jugaa men mening ingkat katkan kan res resiko iko ter terken kenaa kol koleli elitia tiasis sis.. Penggunaan pil kontrasepsi dan terapi hormon (esterogen) dapat meningkatkan
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Orang dengan dengan Body Mass Index (BMI (BMI)) tinggi tinggi,, mempu mempunyai nyai resi resiko ko lebih tinggi untuk unt uk ter terjad jadii kol koleli elitia tiasis sis.. Ini kar karenak enakan an deng dengan an tin tinggi gginya nya BMI mak makaa kad kadar ar kolesterol dalam kandung empedu pun tinggi, dan juga mengurasi garam empedu serta mengurangi kontraksi/ pengosongan kandung empedu. d. Makanan Intake rendah klorida, kehilangan berat badan yang cepat (seperti setelah operasi gatrointes gatro intestinal tinal)) mengak mengakibatka ibatkan n gangguan terhadap unsur kimi kimiaa dari empedu dan dapat menyebabkan penurunan kontraksi kandung empedu. e. Ri Riwa waya yatt ke kelu luar arga ga Orang Ora ng den dengan gan ri riway wayat at kel keluar uarga ga kol koleli elitia tiasis sis mem mempuny punyai ai res resiko iko leb lebih ih bes besar ar dibandingn dengan tanpa riwayat keluarga. f.
Aktifitas fisik Kurang Kur angnya nya akt aktifi ifitas tas fis fisik ik ber berhung hungan an deng dengan an peni peningka ngkatan tan res resiko iko ter terjad jadiny inyaa kole ko leli liti tias asis is.. In Inii mu mung ngki kin n di dise sebab babka kan n ol oleh eh ka kandu ndung ng em empe pedu du le lebi bih h se sedi diki kitt berkontraksi.
g. Pe Peny nyak akit it usu ususs halu haluss rohn disease, disease, Penyakit yang dilaporkan berhubungan dengan kolelitiasis adalah ccrohn diabetes, anemia sel sabit, trauma, dan ileus paralitik. h. Nut Nutris risii intr intraven avenaa jangk jangkaa lama lama Nutrisi intravena jangka lama mengakibatkan kandung empedu tidak terstimulasi untuk berkontraksi, karena tidak ada makanan/ nutrisi yang melewati intestinal. Sehing Seh ingga ga res resiko iko unt untuk uk ter terben bentuk tuknya nya bat batu u men menjad jadii men mening ingkat kat dal dalam am kan kandung dung
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daerah subkapula disertai nausea, vomitus dan dyspepsia, flatulen dan lain-lain. Pada pemeriksaan fisik didapatkan nyeri tekan hipokondrium kanan, dapat teraba pembesaran kandung empedu dan tanda Murphy positif. positif. Dapat juga timbul ikterus. Ikterus dijumpai dijumpai pada pada 20 % kasus, kasus, umumnya umumnya deraja derajatt ringan ringan (bili (bilirub rubin in < 4,0 mg/dl) mg/dl).. Apabil Apabilaa kadar kadar bilirubin tinggi, perlu dipikirkan adanya batu d i saluran empedu ekstra hepatic. Kolik bilier merupakan merupakan keluhan keluhan utama pada sebagian besar pasien. pasien. Nyeri viseral viseral ini berasal dari spasmetonik akibat obstruksi transient duktus sistikus oleh batu. Dengan isti istila lah h
koli kolik k bili bilier er ters tersir irat at peng penger erti tian an bahw bahwaa muko mukosa sa kand kandun ung g empe empedu du tida tidak k
memperlihatkan inflamasi akut. Kolik bilier biasanya timbul malam hari atau dini hari, berlangsung lama antara 30 – 60 menit, menetap, dan nyeri terutama timbul di daerah epigastrium. Nyeri dapat menjalar ke abdomen kanan, ke pundak, punggung, jarang ke abdomen kiri dan dapat menyerupai menyerupai angina pektoris. pektoris. Kolik bilier bilier harus dibedakan dengan gejala gejala dispepsia dispepsia yang merupakan gejala umum pada banyak pasien dengan atau tanpa kolelitiasis. Diagnos Diagnosis is dan pengel pengelola olaan an yang yang baik baik dan tepat tepat dapat dapat menceg mencegah ah terjad terjadiny inyaa komplikasi yang berat. Komplikasi dari batu kandung empedu antara lain kolesistitis akut, kolesistitis kronis, koledokolitiasis, pankreatitis, kolangitis, sirosis bilier sekunder, ileus ileus batu batu empedu, empedu, abses abses hepati hepatik k dan perit peritoni onitis tis karena karena perfor perforasi asi kandung kandung empedu. empedu. Komplikasi tersebut akan mempersulit penanganannya dan dapat berakibat fatal. Sebagian besar (90 – 95 %) kasus kolesititis akut disertai kolelitiasis dan keadaan ini timbul akibat obstruksi duktus sistikus yang menyebabkan peradangan organ tersebut. Pasien Pasien dengan dengan kolesi kolesisti stiti tiss kronik kronik biasan biasanya ya mempuny mempunyai ai koleli kolelitia tiasis sis dan telah telah
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Batu Batu salura saluran n empedu empedu (BSE) (BSE) kecil kecil dapat dapat masuk masuk ke duodenu duodenum m sponta spontan n tanpa tanpa menimbulkan gejala atau menyebabkan obstruksi temporer di ampula vateri sehingga timbul pankreatitis akut dan lalu masuk ke duodenum (gallstone pancreatitis). BSE yang tidak keluar spontan akan tetap berada dalam saluran empedu dan dapat membesar. Gambar Gambaran an klinis klinis koledok koledokoli oliti tiasi asiss didomi didominas nasii penyuli penyulitny tnyaa sepert sepertii ikteru ikteruss obstru obstrukti ktif, f, kolangitis dan pankreatitis.
Gambar 4: Manifestasi klinis yang umum terjadi
2.8 Patofisiologi 2.8.1 Patogenesis Bentukan Batu Empedu
Avni Avni Sali Sali tahun tahun 1984 1984 memb membag agii batu batu empe empedu du berd berdas asar arka kan n komp kompon onen en yang yang
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Batu Ca bilirubinat atau batu pigmen calcium Batu pigmen murni
c) Batu empedu lain yang jarang jarang Sebagian ahli lain membagi batu empedu menjadi: Batu Kolesterol Batu Campuran (Mixed Stone) Batu Pigmen.
Batu Kolesterol
Pembentukan batu Kolesterol melalui tiga fase: a. Fase Fase Sup Super ersa satu tura rasi si Kolesterol, phospolipid (lecithin) dan garam empedu adalah komponen yang yang tak larut larut dalam dalam air. air. Ketiga Ketiga zat ini dalam perban perbandin dingan gan terten tertentu tu memb membent entuk uk mice micell llee yang yang muda mudah h laru larut. t. Di dala dalam m kandu kandung ng empe empedu du keti ketiga gany nyaa dikon dikonse sent ntra rasi sika kan n menj menjadi adi lima lima samp sampai ai tuju tujuh h kali kali lipa lipat. t.
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Pemakaian ian tablet tablet KB (estro (estrogen) gen) sekres sekresii kolest kolestero eroll mening meningkat kat dan Pemaka kadar chenodeoxycholat rendah, padahal chenodeoxycholat efeknya melaru melarutka tkan n batu batu kolest kolestero eroll dan menuru menurunka nkan n satura saturasi si kolest kolestero erol. l. Peneli Penelitia tian n lain lain menyat menyataka akan n bahwa bahwa tablet tablet KB pengaru pengaruhny hnyaa hanya hanya sampai tiga tahun. b. Fase Fase Pemb Pembent entuk ukan an inti inti batu batu Inti batu yang terjadi pada fase II bisa homogen atau heterogen. Inti batu heterogen bisa berasal dari garam empedu, calcium bilirubinat atau sel-sel yang lepas pada peradangan. peradangan. Inti batu yang homogen homogen berasal berasal dari kristal kristal kolesterol sendiri yang menghadap karena perubahan rasio dengan asam empedu. c. Fase Fase Pert Pertumb umbuhan uhan batu batu menja menjadi di besa besar r Untuk menjadi batu, inti batu yang sudah terbentuk harus cukup waktu untuk untuk bisa bisa berkem berkembang bang menjad menjadii besar. besar. Pada Pada keadaan keadaan normal normal dimana dimana kontraksi kandung empedu cukup kuat dan sirkulasi empedu normal, inti batu yang sudah terbentuk akan dipompa keluar ke dalam usus halus. Bila
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b. Batu Batu pigmen pigmen murn murnii (batu (batu non non infek infeksi) si)..
Pembentukan batu bilirubin terdiri dari 2 fase: a. Satu Satura rasi si bil bilir irub ubin in Pada keadaan non infeksi, saturasi bilirubin terjadi karena pemecahan eritrosit yang berlebihan, misalnya pada malaria dan penyakit Sicklecell. Pada keadaan infeksi saturasi bilirubin terjadi karena konversi konjugasi bilirubin menjadi unkonjugasi yang sukar larut. Konversi terjadi karena adanya enzim b glukuronidase yang dihasilkan oleh Escherichia Coli. Pada Pada keadaan keadaan normal normal cairan cairan empedu empedu mengand mengandung ung glokar glokaro o 1,4 lakton lakton yang menghambat kerja glukuronidase. b. Pemb Pemben entu tuka kan n int intii bat batu u Pembentukan inti batu selain oleh garam-garam calcium dan sel bisa juga oleh oleh bakt bakter eri, i, bagi bagian an dari dari para parasi sitt dan dan telu telurr caci cacing ng.. Tats Tatsuo uo Maki Maki melaporkan bahwa 55 % batu pigmen dengan inti telur atau bagian badan dari dari caci cacing ng asca ascari riss lumb lumbri rico coid ides es
Seda Sedang ngkan kan Tung Tung dari dari Viet Vietna nam m
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berkri berkrista stalis lisasi asi dan mem memben bentuk tuk nid nidus us unt untuk uk pem pemben bentuk tukan an bat batu. u. Kri Krista stall yan yang g yan yang g terbentuk terben tuk terba terbak k dalam kandung empedu, kemuadian lama-kelamaan lama-kelamaan kristal tersubut bertambah ukuran,beragregasi, melebur dan membetuk batu. Faktor motilitas kandung biliary ary stasis stasis,, dan kandunga empedu, bili kandungan n empedu merupakan predisposisi predisposisi pembentukan pembentukan batu empedu empedu.
2.9 Komplikasi
Komplikasi yang dapat terjadi pada penderita kolelitiasis: a. As Asim imto tomat matik ik b. Obst Obstruksi ruksi duktus sist sistikus ikus c. Ko Koli lik k bi bili lier er d. Kol Kolesi esisti stitis tis aku akutt Empiema Perikolesistitis Perforasi
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ataupun dapat terjadi perforasi kandung empedu yang berakibat terjadinya peritonitis generalisata. Batu kandung empedu dapat maju masuk ke dalam duktus sistikus pada saat kontraksi dari kandung empedu. Batu ini dapat terus maju sampai duktus koledokus kemudi kem udian an men meneta etap p asi asimto mtomat matis is ata atau u kada kadang ng dapa dapatt men menyeb yebabka abkan n kol kolik. ik. Bat Batu u yan yang g menyumbat di duktus koledokus juga berakibat terjadinya ikterus obstruktif, kolangitis, kolangiolitis, dan pankretitis. Batu kandung empedu dapat lolos ke dalam saluran cerna melalui terbentuknya fistel kolesitoduodenal. Apabila batu empedu cukup besar dapat menyumbat pad bagian tersempit saluran cerna (ileum terminal) dan menimbulkan ileus obstruksi.
2.10
Diagnosis
2.10.1 Anamnesis
Setengah Seten gah sampa sampaii duaper duapertiga tiga penderi penderita ta kolel kolelitia itiasis sis adala adalah h asint asintomati omatis. s. Keluha Keluhan n yang mungkin timbul adalah dispepdia yang kadang disertai intoleran terhadap makanan berlemak. berlemak. Pada yang simtomatis, simtomatis, keluhan utama berupa nyeri di daerah epigastrium, epigastrium,
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empedu, emp edu, emp empiem iemaa kan kandung dung emp empedu, edu, ata atau u pan pangkr gkreti etiti tis. s. Pad Padaa pem pemeri eriksa ksaan an ditemukan nyeri tekan dengan punktum maksimum didaerah letak anatomis kandung kand ung emp empedu edu.. Tan Tanda da Mur Murphy phy pos positi itiff apa apabil bilaa nye nyeri ri tek tekan an ber bertam tambah bah sewakt sew aktu u pend penderi erita ta men menari arik k naf nafas as panj panjang ang kar karena ena kan kandung dung emp empedu edu yan yang g meradang tersentuh ujung jari tangan pemeriksa dan pasien berhenti menarik nafas. Batu saluran empedu
Baru saluran empedu tidak menimbulkan gejala dalam fase tenang. Kadang teraba hatidan sklera ikterik. Perlu diktahui bahwa bila kadar bili bilirubin rubin darah
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Kada Ka dang ng ka kandu ndung ng em empe pedu du ya yang ng me meng ngan andun dung g ca cair iran an em empe pedu du be berk rkad adar ar kalsiu kal sium m tin tinggi ggi dapa dapatt dil diliha ihatt deng dengan an fot foto o pol polos. os. Pad Padaa per peradan adangan gan aku akutt dengan kandung empedu yang membesar atau hidrops, kandung empedu kadang terlihat sebagai massa jaringan lunak di kuadran kanan atas yang menekan gambaran udara dalam usus besar, di fleksura hepatica.
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usus. usu s. Den Dengan gan USG punktum punktum mak maksim simum um ras rasaa nye nyeri ri pada batu kand kandung ung empedu yang ganggren lebih jelas daripada dengan palpasi biasa.
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Jika tidak ditemukan gejala, maka tidak perlu dilakukan pengobatan. Nyeri yang hilanghil ang-tim timbul bul bis bisaa dih dihind indari ari ata atau u dik dikura urangi ngi deng dengan an men menghi ghindar ndarii ata atau u men mengur gurang angii makanan berlemak. Pilihan penatalaksanaak antara lain: a) Ko Kole lesi sist stekt ektom omii terbu terbuka ka Operasi ini merupakan standar terbaik untuk penanganan pasien denga kolelitiasis simtomatik. Komplikasi yang paling bermakna yang dapat terjadi adalah cedera duktus biliaris yang terjadi pada 0,2% pasien. Angka mortalitas yang dilaporkan untu un tuk k pr pros osedu edurr in inii ku kura rang ng da dari ri 0, 0,5% 5%.. In Indi dikas kasii ya yang ng pa pali ling ng um umum um unt untuk uk kolesistektomi adalah kolik biliaris rekuren, diikuti oleh kolesistitis akut. b) Kol Kolesi esi
ktomi kto mi l
kopii kop
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Masala Mas alah h umu umum m yan yang g men mengga gganggu nggu sem semua ua zat yan yang g per pernah nah dig diguna unakan kan ada adalah lah angka kekambuhan yang tinggi dan biaya yang dikeluarkan. Zat disolusi hanya memper mem perlih lihatk atkan an man manfaa faatny tnyaa unt untuk uk bat batu u emp empedu edu jen jenis is kol kolest estero erol. l. Pen Peneli elitia tian n prospektif acak dari asam xenodeoksikolat telah mengindikasikan bahwa disolusi dan hilangnnya batu secara lengkap terjadi sekitar 15%. Jika obat ini dihentikan, kekambuhan batu tejadi pada 50% pasien. d) Di Diso solu lusi si ko kont ntak ak Meskipun pengalaman masih terbatas, infus pelarut kolesterol yang poten (metilter-butil-eter (MTBE)) ke dalam kandung empedu melalui kateter yang diletakkan per kutan telah terlihat efektif dalam melarutkan batu empedu pada pasien-pasien
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Komposisi: Hiosina N-bultilbromida 10 mg/tablet, 20 mg/ml injeksi.
Indikasi: si: Ganggua Gangguan n kejang kejang gastro gastroint intest estinu inum, m, empedu, empedu, salura saluran n kemih kemih Indika wanita.
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A. Pengkajian
Aktifitas/Istirahat Gejala
: Kelemahan
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Tanda
: Demam, menggigil. Ikterik, dengan kulit berkeringat dan gtal (Pruiritus). Kecenderungan perdarahan (kekurangan vitamin K).
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Foto abdomen (mult (multiposis iposisi): i): Menya Menyatakan takan gambar gambaran an radio radiologi logi (kals (kalsifik ifikasi) asi) batu empedu, kalsifikasi dinding atau pembesaran kandung empedu. Foto dada: Menunjukan pernapasan yang menyebapkan penyebaran nyeri.
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4. Kurang Kurang pengetahuan berhubungan berhubungan dengan salah interpretas interpretasii informasi, informasi, tidak mengenal sumber informasi.
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