HEPATOBILIARY SYSTEM

Soeprianto Wiradjaja SpB

RS. SUMBER WARAS

2010
Organs Hepatobiliary System

1. Liver
2. Gall Bladder
3. Ductus hepaticus
4. Ductus choledocus
5. Pancreas
6. Duodenum
Disease of Hepatobiliary System

1. Cholelithiasis
2. Choledocholithiasis
3. Liver Abscess
4. Liver Tumor (Hepatoma)
5. Liver Cyst
6. Hemangioma
7. Metastase
8. Neoplasma
 CHOLELITHIASIS

 Definition : gallstones
 Stones : Pigment stones, cholesterol stones, etc
 People with gallstones can be divided into 4 groups :
1. chronic cholecystitis caused inflammation the
gall bladder.
2. acute cholecystitis because obstruction of the
cystic duct by stones.
3. asymptomatic (silent stone)
4. symptomatic
 SYMPTOMATIC

 cholelithiasis non –itis, Symptoms : discomfort with

regio epigastrium bloating especially after eating
greasy foods that are considered gastritis.

 cholelithiasis with chronic cholecystitis, symptoms :

abdominal superior dextra pain referred to scapula.
murphy sign (+)

 cholelithiasis with acute cholecystitis, symptoms :

abdominal superior dextra colic pain referred to
scapula, murphy sign (+), tremble, and febris.
Clinical Acute Cholecystitis
• Obstruction of the cysticus duct

• INFECTED BILE STASIS

• Transparent bile (GALLBLADDER HIDROPS).

• Purulent bile (GALLBLADDER EMPYEMA)

• Push vascular can be phlegmonosa and gangrenosa gall bladder

• PERFORATE

• PERITONITIS

• SEPTIC SYOCK

•†
 DIAGNOSTIC

 ULTRASONOGRAPHY
 ct – scan
 mrcp
 ercp
 LABORATORY

 Routine Lab (Hb, Ht, Leukocyte, Trombocyte,

Eritrocyte)
 Specific Lab (SGOT, SGPT, Bilirubin, Alkali
phospatase, Amylase, Lypase, dan Tumor marker)
 TREATMENT

 Laparascopic cholecystectomy
 Conventional cholecystectomy
1. What organs including hepatobiliary system?
2. What surgical disease is found on the hepatobiliary
system?
3. Describe the anatomy of the hepatobiliary system!
4. What type of stone found on cholelithiasis?
5. What causes the occurrence of acute and chronic
cholecystitis?
6. What diagnostic support can be used?
7. How is the treatment ?
 CASE 1

 A 40-year-old woman, overweight, complaining of

discomfort and pain in the pit of the stomach treated
at the general practice and in diagnostics as gastritis,
but the complaint was not reduced. What are you
going to do next?

 USG examination and if necessary gastroscopy,

laboratory examinations and refer to a GENERAL
surgeon.
 CASE 2

 A 40-year-old woman, complained of colic pain

upper right abdomen accompanied by febrile and
shivering. Anamnestic found a history of
cholelithiasis. What's your next action?

 Refer to a GENERAL surgeon for the planned

laparascopic cholecystectomy after preparatory
operations such as laboratory tests, repeated USG
if necessary