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Dr. LEIVER RIVERA. MEDICO CIRUJANO. UNIVERSIDAD LAICA ELOY ALFARO DE MANABI HOSPITAL RAFAEL RODRIGUEZ ZAMBRANO. MANTA –MANABI – ECUADOR. ABRIL -2012
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Es un síndrome clínico-humoral clínico-humoral caracterizado por ictericia, coluria y acolia, con aumento a las cifras de bilirrubina directa, colesterol y fosfatasa alcalina, en sangre, debido a la obstrucción completa completa de la vía biliar extra hepática
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Anemia hemolítica.
Enfermedad de Caroli: Estrecheces o dilataciónes congénitas.
Parasitosis hepatobilliar.
Cálculo en vía biliar que progresa.
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Dolor epigástrico irradiado a hipocondrio derecho y dorso
Náuseas.
Vómitos. Acolia. Coluria.
Ictericia. Fiebre intermitente con escalofríos. Tríada de Charcot.
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A.
ANALISIS CLINICOS.-
Incremento de la bilirrubina bilirrubina total superior a 2 mgr mgr %;con predominio de la bilirrubina directa.(+45% en relación a la B.I) .
Aumento del colesterol y fosfatasa alcalina.
La Fal. Para confirmar confirmar se debe pedir la 5 nucleotidasa. nucleotidasa.
Disminución del tiempo de protrombina.
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Se observa colédoco dilatado.
•
Dilatación de las vías biliares intrahepáticas. •
Cálculo en colédoco.
•
Adenomegalias biliar. •
del
pediculo
Agrandamiento de cabeza del
•
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Presencia de tumores ampulares.
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Punción hepática a través de la pared anterior del abdomen a nivel del hipocondrio derecho con aguja fina llamada Okuda – shiva, shiva, se localiza un canalículo biliar dilatado por medio de intensificador de
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De elección en sospecha de Ca. De cabeza de pancreas.
•
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inicial general, consistirá en mejorar el estado de hidratación y corregir el El tratamiento El tratamiento inicial medio interno (hipopotasemia, hipocloremia, hiponatremia, etc). Iniciar un esquema de antibióticos de amplio espectro y que tuvieran concentración/eliminación optima en la vía biliar como cefalosporinas de 1, 2 ó 3era
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