Colecistolitiasis

COLECISTOLITIASIS
La vesícula biliar es el órgano que se encarga de almacenar y enviar al intestino la bilis producida en el hígado, la bilis es necesaria para la digestión de las grasas, este órgano digestivo es del tamaño aproximado de un higo y se encuentra por debajo del hígado, cuenta con un conducto de salida, que a su vez conecta con el conducto principal del hígado.

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COLECISTOLITIASIS
Es la presencia de cálculos en la vesícula biliar

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COLECISTITIS
Es la inflamación de la vesícula causada usualmente por la obstrucción del conducto de salida de la misma vesícula por cálculos (piedras, litos)

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Cada vez que una persona come, sobre todo grasa, la vesícula se contrae para vaciar la bilis y llevar a cabo en el intestino la digestión de las grasas, si existe la presencia de una piedra (LITO) la salida de la bilis no ocurre y la vesícula inicia un proceso de contracción más intenso con el fin de vencer la resistencia de salida ,ocasionando con esto un cólico biliar (espasmo vesicular agudo) , si la contracción persiste ,se inicia un proceso inflamatorio en las paredes de la vesícula , aunado a la posibilidad de que la bilis se infecte, estableciendo con esto un cuadro agudo .
(Obstrucción, contracción, inflamación, infección)

FACTORES DE RIESGO
Mujeres, en edad fértil (entre 20 – 40 años), con sobrepeso
Uso de Anticonceptivos orales
El riesgo se va acumulando, a mayor edad más probabilidad de tener cálculos.
LOS CÁLCULOS PUEDEN SER DE 3 TIPOS
De pigmento, De colesterol y mixtos

NO EXISTE MEDICAMENTO QUE LOS DESHAGA definitivamente, ni alopático, ni homeopático.

PRESENTACION CLINICA
La mayor parte de los pacientes portadores de cálculos biliares son asintomáticos, cuando hay síntomas, se presenta con dolor en la parte superior del abdomen, típico dolor cólico después de ingesta de comidas, especialmente si son muy grasosas.
El dolor puede durar horas y en algunos casos no cede hasta que se intervenga de alguna manera, en otros casos duele un poco y remite.
Cuando hay dolor la persona tiene sudoración fría, inquietud y en algunos casos puede tener fiebre, que es el aviso de una complicación. Puede acompañarse de vomito, sensación de plenitud abdominal y distensión abdominal.
DIAGNÓSTICO

Se sospecha ante la presencia de los síntomas mencionados y se fortalece esta impresión con los datos recabados por la exploración física.
Se comprueba la mayor parte de las veces mediante una ecosonografía (ECO de abdomen) que demuestra la presencia de las piedras y el estado de las paredes de la vesícula, (Tamaño, grosor, datos de inflamación)
Exámenes de sangre son necesarios para evaluar la función del hígado y del páncreas, que frecuentemente pueden estar asociados a las complicaciones de esta enfermedad.

TRATAMIENTO
OBJETIVOS

En general el paciente debe ser tratado en ambiente hospitalario.
Calmar el dolor: es el primer objetivo
Reemplazo de fluidos
Antibióticos con evidencia de infección
Exámenes de valoración

El Objetivo final es la resolución definitiva del cuadro

La remoción de la vesícula con los cálculos en su interior es la meta de la cirugía, existen dos métodos:
Cirugía tradicional.-
Mediante anestesia general, llevar a cabo una cirugía abdominal abierta, con una incisión amplia.
Cirugía Laparoscópica.-
(Laparoscopia, significa: ver a través de la pared)
Mediante anestesia general llevar a cabo una técnica de incisión mínima.

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Las ventajas de esta son: menor tiempo de recuperación, menor dolor postoperatorio, rápida incorporación a actividades cotidianas, cicatriz pequeña, sumamente eficaz en manos experimentadas.

La elección del tratamiento dependerá de cada paciente y su estado general
COMPLICACIONES

Las complicaciones tienden a presentarse después de varios cuadros de dolor agudo, aunque a veces en el primer cuadro doloroso pueden aparecer.
Las complicaciones locales (vesiculares) implican que, la vesícula se ha infectado, o que el cuadro de inflamación es tan extenso que las paredes del órgano ya no son recuperables.
Las complicaciones a otros órganos, implican que la obstrucción del cálculo ya no es solo de la vesícula sino que ha migrado y ahora ocluye los conductos hepáticos, o peor aun, el conducto pancreático.
En casos extremos la vesícula puede perforarse y comunicar a otros órganos creando un conducto anormal por el cual los cálculos pueden salir y obstruir el intestino.
Se ha relacionado la presencia de cálculos biliares al cáncer vesicular


Dr. Jorge E. Balli Martínez
Cirugía Laparoscópica
Gastroenterología Quirúrgica

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