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Anatomía, fisiología y métodos de estudio de la vesícula y vias biliares.

Author: jesus-otoniel-martinez-ortega

Post on 25-Jan-2017

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  • Anatoma, fisiologa y mtodos de estudio de la vescula y vias biliares.

  • heptico comn csticocoldocopancretico comn (Wirsung)ampolla de Vater esfnter de Oddi2a porcin del duodeno

  • Funciones de la vescula biliarAlmacenar y concentrar la bilis heptica.Vaciarla al intestino al recibir estmulos neurohumorales.Capacidad: 40 ml, absorcin 15-30% del volumen/hora.DP negativo entre mucosa y serosa: 18-20 mV.

  • Actividad motora vesicularcontrol neuralInervacin adrenrgica escasa: vasos sanguneos.Agonistas colinrgicos: contraccin muscular.Agonistas beta adrenrgicos: relajacin.PIV antagoniza el efecto contrctil de la CCK.

  • Actividad motora vesicularcontrol hormonalColecistocinena (CCK): hormona duodenoyeyunal > grasas y protenas.Formas: CCK 39, 33, 8 (la ms potente).Efecto migeno directo: cAMP, cGMP.Contrae la vescula y relaja el esfnter de Oddi.

  • Fases de la motilidad de la vescula biliaren ayunas (fase I en ayunas (fase II tras la ingesta en el estmago en el estmago 0.3 ml/min 0.6 ml/min 0.5 ml/min

  • Funcin vesicular: almacenamiento y contraccin

  • La colecistocinena (CCK) en la contraccin vesicular

  • Composicin de la bilis hepticaFRACCIONES: canalicular dependiente de cidos biliares. canalicular independiente de c. biliares.

    ductular.Agua y electrlitos, isotnica: 95%.Solutos orgnicos: 5%

  • Fisiologa de la vescula biliar: absorcinUn solo tipo celular en la mucosa.No hay mecanismo independiente de Na para solutos orgnicos.Entrada acoplada de Na y Cl.Absorcin de agua acoplada, pasiva, osmtica.Otros liposolubles: bilirrubina libre pequeas hidrosolubles (urea)

  • Mtodos de estudio de la vescula y vias biliaresHistoria clnica.Bh, qs, pfh.Radiolgicos: PSA, TAC, CPRE.Ultrasonograma, US endoscpico.Medicina nuclear.Duodenoscopia.RMN.Colecistografa oral e IV.

  • Vescula de porcelana(se complica con adenocarcinoma en 30%)PLACA SIMPLE DEL ABDOMEN

  • ULTRASONOGRAMA

    COLECISTOGRAFA ORALTAC

  • DUODENOSCOPIA: clculo asomando por el mpula de Vter

  • colangiopancreatografa endoscpica (CPRE)

  • CPRE EN ICTERICIA

    *Figure 9-2. A, This CT scan shows a hyperdense focus (arrow) in the distal common bile duct, with surrounding hypodense bile within an enormously dilated common bile duct. B, The magnetic resonance cholangiopancreatogram reveals multiple filling defects of varying size throughout the entire extrahepatic biliary tree within a tortuous and dilated common bile duct and prominent intrahepatic ducts. C, The corresponding cholangiogram obtained at endoscopic retrograde cholangiopancreatography is shown. (B,Courtesy of Robert Whitlock, New York, NY.)

  • CPRE EN ICTERICIA-II

    *Figure 9-3. Endoscopic retrograde cholangiopancreatography is the most accurate invasive diagnostic modality and can clearly demonstrate intraluminal filling defects as well as ductal dilatation (A). Other diagnostic modalities, depending on availability and local expertise, include percutaneous cholangiography, intraoperative cholangiography (obtained laparoscopically in panel B), and common bile duct exploration, performed laparoscopically or by an open approach. Surgical and endoscopic ductal clearance rates are usually reported to be greater than 95%. Mortality rates for surgical series range from 0% to 28%, depending on the patient populations selected, and recurrence rates range from 5% to 21%. In contrast, endoscopic ductal clearance has a published mortality rate ranging from 0% to 3% and a recurrence rate of less than 5%.

  • RMN EN ICTERICIA

    *Figure 9-2. A, This CT scan shows a hyperdense focus (arrow) in the distal common bile duct, with surrounding hypodense bile within an enormously dilated common bile duct. B, The magnetic resonance cholangiopancreatogram reveals multiple filling defects of varying size throughout the entire extrahepatic biliary tree within a tortuous and dilated common bile duct and prominent intrahepatic ducts. C, The corresponding cholangiogram obtained at endoscopic retrograde cholangiopancreatography is shown. (B,Courtesy of Robert Whitlock, New York, NY.)

  • LAPAROCOLANGIOGRAFA

    *Figure 9-3. Endoscopic retrograde cholangiopancreatography is the most accurate invasive diagnostic modality and can clearly demonstrate intraluminal filling defects as well as ductal dilatation (A). Other diagnostic modalities, depending on availability and local expertise, include percutaneous cholangiography, intraoperative cholangiography (obtained laparoscopically in panel B), and common bile duct exploration, performed laparoscopically or by an open approach. Surgical and endoscopic ductal clearance rates are usually reported to be greater than 95%. Mortality rates for surgical series range from 0% to 28%, depending on the patient populations selected, and recurrence rates range from 5% to 21%. In contrast, endoscopic ductal clearance has a published mortality rate ranging from 0% to 3% and a recurrence rate of less than 5%.

  • CENTELLOGRAFA BILIAR CON IDA MARCADO

  • ULTRASONOGRAMA ENDOSCPICO vescula normal vista desde el duodeno coldoco y porta

    *Figure 9-2. A, This CT scan shows a hyperdense focus (arrow) in the distal common bile duct, with surrounding hypodense bile within an enormously dilated common bile duct. B, The magnetic resonance cholangiopancreatogram reveals multiple filling defects of varying size throughout the entire extrahepatic biliary tree within a tortuous and dilated common bile duct and prominent intrahepatic ducts. C, The corresponding cholangiogram obtained at endoscopic retrograde cholangiopancreatography is shown. (B,Courtesy of Robert Whitlock, New York, NY.)*Figure 9-3. Endoscopic retrograde cholangiopancreatography is the most accurate invasive diagnostic modality and can clearly demonstrate intraluminal filling defects as well as ductal dilatation (A). Other diagnostic modalities, depending on availability and local expertise, include percutaneous cholangiography, intraoperative cholangiography (obtained laparoscopically in panel B), and common bile duct exploration, performed laparoscopically or by an open approach. Surgical and endoscopic ductal clearance rates are usually reported to be greater than 95%. Mortality rates for surgical series range from 0% to 28%, depending on the patient populations selected, and recurrence rates range from 5% to 21%. In contrast, endoscopic ductal clearance has a published mortality rate ranging from 0% to 3% and a recurrence rate of less than 5%.*Figure 9-2. A, This CT scan shows a hyperdense focus (arrow) in the distal common bile duct, with surrounding hypodense bile within an enormously dilated common bile duct. B, The magnetic resonance cholangiopancreatogram reveals multiple filling defects of varying size throughout the entire extrahepatic biliary tree within a tortuous and dilated common bile duct and prominent intrahepatic ducts. C, The corresponding cholangiogram obtained at endoscopic retrograde cholangiopancreatography is shown. (B,Courtesy of Robert Whitlock, New York, NY.)*Figure 9-3. Endoscopic retrograde cholangiopancreatography is the most accurate invasive diagnostic modality and can clearly demonstrate intraluminal filling defects as well as ductal dilatation (A). Other diagnostic modalities, depending on availability and local expertise, include percutaneous cholangiography, intraoperative cholangiography (obtained laparoscopically in panel B), and common bile duct exploration, performed laparoscopically or by an open approach. Surgical and endoscopic ductal clearance rates are usually reported to be greater than 95%. Mortality rates for surgical series range from 0% to 28%, depending on the patient populations selected, and recurrence rates range from 5% to 21%. In contrast, endoscopic ductal clearance has a published mortality rate ranging from 0% to 3% and a recurrence rate of less than 5%.