ecografia biliara
DESCRIPTION
ecografia reprezinta in prezent prima optiune imagistica in patologia tractului biliarTRANSCRIPT
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Ultrasonografia Ultrasonografia tractului biliartractului biliar
Dr. Alexandru AndritoiuDr. Alexandru Andritoiu
Sp. Clinic Militar de UrgentaSp. Clinic Militar de Urgenta
Craiova Craiova
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IntroducereIntroducere
US – prima linie de explorare in patologia US – prima linie de explorare in patologia biliara biliara
Diagnostic acurat in litiaza VB, dar mai limitat Diagnostic acurat in litiaza VB, dar mai limitat in litiaza coledocianain litiaza coledociana
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IndicatiiIndicatii
Colecistita acutaColecistita acuta:: durere in hipocondrul dr. semn durere in hipocondrul dr. semn Murphy pozitiv, aparare subcostala dr., febra, greata si Murphy pozitiv, aparare subcostala dr., febra, greata si varsaturi, hiperleucocitoza cu formula deviata la stg. varsaturi, hiperleucocitoza cu formula deviata la stg.
Colica biliaraColica biliara:: durere intensa in hipocondrul dr. cu durere intensa in hipocondrul dr. cu iradiere in aria interscapulara, teste sanguine normale. iradiere in aria interscapulara, teste sanguine normale.
ColangitaColangita:: sugerind obstructia tractului biliar asociata cu sugerind obstructia tractului biliar asociata cu durere in hipocondrul dr., febra si icter. durere in hipocondrul dr., febra si icter.
Pancreatita ac. biliaraPancreatita ac. biliara: durere intensa in epigastru, cu : durere intensa in epigastru, cu debut brusc, continua, cu iradiere posterioara, varsaturi, debut brusc, continua, cu iradiere posterioara, varsaturi, cresterea amilazelor (3 x ) la un pacient cu istoric de cresterea amilazelor (3 x ) la un pacient cu istoric de litiaza biliara. litiaza biliara.
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Metode de explorare USMetode de explorare US
2D (RT)2D (RT)3D3DTissue harmonic imaging (THI)Tissue harmonic imaging (THI)Sono-CTSono-CTUS endoscopicaUS endoscopicaUS intraluminala (CBP)US intraluminala (CBP)
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Semiologia USSemiologia US
Vezica biliaraVezica biliara DimensiuniDimensiuni Grosime pereteGrosime perete Continut Continut SepturiSepturi CuduriCuduri
Calculii biliariCalculii biliari Ecostructura (con de umbra )Ecostructura (con de umbra ) NumarNumar DimensiuniDimensiuni LocalizareaLocalizarea Mobilitatea cu pozitiaMobilitatea cu pozitia
Calea biliara principalaCalea biliara principala CalibruCalibru Lumen liberLumen liber Ocluzie/subocluzieOcluzie/subocluzie
Date conexeDate conexe Ficat tumoral/ciroticFicat tumoral/cirotic Adenopatii in hilAdenopatii in hil Tromboza VPTromboza VP Cavernom portalCavernom portal Pancreas tumoral/pseudochistPancreas tumoral/pseudochist
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VEZICA BILIARAVEZICA BILIARA
DATE NORMALEDATE NORMALE Rol de rezervorRol de rezervor Continut transonicContinut transonic Aspect piriformAspect piriform Variabil pre/postprandialVariabil pre/postprandial Perete finPerete fin
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Patologia VBPatologia VB
Patologie acutaPatologie acuta Ingrosarea pereteluiIngrosarea peretelui Marirea de volumMarirea de volum Continut ecogenContinut ecogen Semn Murphy ecograficSemn Murphy ecografic
Patologie cronicaPatologie cronica perete ingrosatperete ingrosat calculicalculi masa tumoralamasa tumorala marirea de volummarirea de volum septurisepturi hepatizatiehepatizatie
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VB – marire de volumVB – marire de volum((hidrops)hidrops)
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Varice perete colecistVarice perete colecist(ciroza hepatica)(ciroza hepatica)
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VB perete ingrosatVB perete ingrosat(colecistita cronica pseudotumorala)(colecistita cronica pseudotumorala)
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Colecist pseudotumoralColecist pseudotumoral
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Colecist pseudotumoralColecist pseudotumoral
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Calcul unic VBCalcul unic VB
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Calcul inclavatCalcul inclavat
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Colecist ocupatColecist ocupat
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Calculi multipli - VBCalculi multipli - VB
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Calcul hiperecogenCalcul hiperecogen(con de umbra posterior)(con de umbra posterior)
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Calculi hipoecogeniCalculi hipoecogeni
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Calculi mici multipli Calculi mici multipli
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Noroi biliarNoroi biliar
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Colecistita acuta litiazicaColecistita acuta litiazica
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Calecistita acuta litiazicaCalecistita acuta litiazica
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Colecistita acuta litiazicaColecistita acuta litiazica
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Colecistita acuta litiazaColecistita acuta litiaza
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Colecistita cronica litiazicaColecistita cronica litiazica
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Calculi inglobati in noroi biliarCalculi inglobati in noroi biliar
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Calcul mare inclavatCalcul mare inclavat
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Litiaza biliara– ciroza hepaticaLitiaza biliara– ciroza hepatica
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CBP - CBIHCBP - CBIH
CalibruCalibruLumen liberLumen liberLumen ocupat Lumen ocupat CBIH dilatate – icter mecanicCBIH dilatate – icter mecanic
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CBP dilatata CBP dilatata (icter mecanic)(icter mecanic)
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Canal biliar Canal biliar (transductor liniar 7.5 MHz)(transductor liniar 7.5 MHz)
D = 1.1 mm
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Litiaza coledocianaLitiaza coledociana
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Litiaza coledocianaLitiaza coledociana
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Litiaza coledocianaLitiaza coledociana(icter mecanic)(icter mecanic)
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Litiaza CBP- subocluzivaLitiaza CBP- subocluziva
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Icter mecanicIcter mecanic
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Caile biliare IH dilatateCaile biliare IH dilatate(icter mecanic)(icter mecanic)
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Venele hepatice vs CBIHVenele hepatice vs CBIH
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Ascaridiaza biliaraAscaridiaza biliara
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Aportul DopplerAportul DopplerVV porta vs CBP porta vs CBP
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Litiaza intra-hepaticaLitiaza intra-hepatica
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Falsa litiaza intrahepaticaFalsa litiaza intrahepatica
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Date conexeDate conexe
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V porta (cavernom)V porta (cavernom)
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Tromboza V portaTromboza V porta(neoplazica)(neoplazica)
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Tumora cefalopancreaticaTumora cefalopancreatica
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Pseudochist cap pancreasPseudochist cap pancreas
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Adenopatii in hilul hepaticAdenopatii in hilul hepatic
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Diagnostic diferentialDiagnostic diferential(antru gastric)(antru gastric)
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Falsa adenomiomatozaFalsa adenomiomatoza(calculi mici hipoecogeni)(calculi mici hipoecogeni)
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PROGRESE TEHNICEPROGRESE TEHNICE
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Eco standard vs THIEco standard vs THI
Calcul in canalul hepatic dreptEco standard
Calcul vizualizat prin metoda tissue harmonic
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Acuratetea diagnostica THIAcuratetea diagnostica THI
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US endoluminala (CBP)US endoluminala (CBP)
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ECOGRAFIST - CHIRURGECOGRAFIST - CHIRURG
O ECHIPA ?O ECHIPA ?
CALEA BILIARA = O CALE COMUNA
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Predictia US a complicatiilor chirurgiei Predictia US a complicatiilor chirurgiei laparoscopice (conversia)laparoscopice (conversia)
Factori US (scor)Factori US (scor) Marimea VBMarimea VB Nr. calculilorNr. calculilor Dimensiunea calculilorDimensiunea calculilor Localizarea calculilor in VBLocalizarea calculilor in VB Grosimea peretilor VBGrosimea peretilor VB Diametrul CBPDiametrul CBP Dimensiunile ficatuluiDimensiunile ficatului
Factori NonUSFactori NonUS VirstaVirsta SexulSexul IMCIMC Aderente postoperatoriiAderente postoperatorii
(Corr P 1994, Fried GM 1994, Carmody E 1994, Urbano D 1996, Snatambrogio R 1996, Daradkeh S 1998)
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US -IOPUS -IOP
FICAT – SCANARE META
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US - IOPUS - IOP
HIL HEPATIC