Guia de Colecistitis Aguda Modif Ultra

7/25/2019 Guia de Colecistitis Aguda Modif Ultra

1/17

GUA DE PRCTICA CLNICA DE COLECISTITIS AGUDADEPARTAMENTO DE CIRUGA

HOSPITAL REGIONAL GUILLERMO DIAZ DE LA VEGA2015

I. NOMBRE Y CODIGO:

Clculo d l! "#$cul! %&l&!' co( colc)&) !*ud! CI+, 10- ./00Colc)&) A*ud! #&( clculo CI+, 10-./10

II. DEFINICIN:E# l 'oc#o &(!3!)o'&o !*udo d l! V#$cul! 4&l&!' %!c)'&!(! ou$3&c! El 607658 d lo# c!#o#- # c!u#!do o' l! '#(c&! d clculo#%&l&!'# u o%#)'u9( l co(duc)o c$#)&co- l! %&l !)'!!d! # co(c()'!9 c!u#! &''&)!c&:( 9 !cu3ul!c&:( d '#&:( ( l! "#$cul!- 'oduc&(do

'ol&;'!c&:( %!c)'&!(!- ';o'!c&:( 9 '&)o(&)FRECUENCIA:L! Litiasis Vesicular # (cu()'! ( l 108 d l! o%l!c&:( !dul)!-ll*!(do ! 508 ( !l*u(o# !$## D #)o# l 10 ! 208 d#!''oll!'(cu!d'o# d Colecistitis Agua co( &(c&d(c&! 3# !l)! ( l #,1 '#c)o ! lo# "!'o(#? A !')&' d lo# 50 !@o#- !#! ! #'d 5 ! 1L! Colecistitis Agua Aliti!sica # l! &(!3!c&:( !*ud! d l! "#$cul!%&l&!' ( !u#(c&! d clculo#- co(#)&)u9 u( ! /8 d )odo# lo# c!#o#d colc)&) !*ud! E( l! Bl)&3! dc!d! # ! &(c'3()!do !#)! u(18- #&(do 3# co3B( ( l #


2/17

( l! !)o*(# d l! colc)&) !l&)&!#&c! ( l! 3!9o'$! d lo# c!#o## o' u(! 'ducc&:( ( l! c!!c&d!d d "!c&!3&()o d l! "#$cul!-#&(do l!# '&(c&!l# c!u#!#, ##- )'!u3!)o#- !;cc&o(# dlcol*(o- l #$(d'o3 d &(3u(odc&(c&! !du&'&d! 9 d&!%)#O)'!# )&olo*$!# ud( #' l! "ol"ul!c&:( d l! "#$cul! %&l&!'- l!

!(*ul!c&:( dl #&;:( "#&cul!'- )u3o'# %(&*(o#- u)#- l c(c'"#&cul!'- 9 !(o3!l$!# "!#cul!'#-


3/17

H!9 %' ( /08 d lo# c!#o#- !u(u ud #)!' !u#() (!(c&!(o# : ( u&(# co(#u3( #)'o&d# u o)'o#!()&&(!3!)o'&o#

L! !l!c&:( dl !%do3( # dolo'o#!- #c&!l3() (&oco(d'&o d'co co( &'#(#&%&l&d!d ( l cu!d'!() #u'&o'

d'co- l &*!#)'&o o !3%o# #&)&o# C'c! d 508 d lo#!c&()# '#()!( '&*&d 3u#cul!' ( l cu!d'!() #u'&o'd'co- 9 !l'ddo' dl 258 )&(( #(#&%&l&d!d d '%o)-

D&(uc&:( d 'u&do# &()#)&(!l# # ;'cu() ( =108?- ! 3(o#u # !9! 'oduc&do '&)o(&) *('!l&!d! $lo !'!l$)&co Sud &d()&c!' u(! 3!#! !l!%l ( l! '*&:( "#&cul!' =08?u ud #' l! "#$cul! o l &l:( !d'&do ! #)! o' ;c)od l! &(!3!c&:( E( )!!# )!'d$!# ud #&*(&c!' l d#!''ollod u( !%#c#o '&colc$#)&co

L! &c)'&c&! cu!(do #) '#()- #olo # "&d() ( l!# #cl'!#=208? 9 #u*&' l! o#&%&l&d!d d coldoco l&)&!# co(co3&)!()- l!u ud #' d u( 10 ! 158 d )odo# lo# c!#o# El sig(o eMur)*+$ u co(#) ( l! &()''uc&:( d l! &(#&'!c&:( o' dolo'du'!() l! !l!c&:( 'o;u(d! dl cu!d'!() #u'&o' d'co- (o# u( d!)o co(#)()- 'o # c!#& patognomnico cu!(do #'#()!

Rco'd!' u, Cu!(do l d&!*(:#)&co ( u( !dul)o co( dolo'!%do3&(!l !*udo- #


4/17

E'AMENE% AU'ILIARE%D%3o# 'co'd!' u #)o# #)ud&o# )&(( u(! #(#&%&l&d!d 9#c&c&d!d u (o !lc!(!( 1008- # dc&'

4&l&''u%&(! #'&c! !u3()!d! ( 508 d lo# !c&()#- )!3%&(!9 &(c'3()o dc')o d !3&l!#! #'&c!- d )'!(#!3&(!#!# 9

;o#;!)!#! !lc!l&(!/- E%"UDIO% DE IMAGEN.

R!d&o*'!;$! #&3l d !%do3(- "&( d)'3&(!d! o' l!


5/17

%o'd 3!ld(&do d l! !'d d l! "#$cul! %&l&!' ( &()';!# co( l $*!do- !(&llodl*!do d l$u&do '&colc$#)&co- !u3()o d l! d(#&d!d d l! %&l L! 'u%! #c$c! d colc)&) !*ud! # l! colegammagrafa co(c&do &3&(od&!c)&co =IDA? 3!'c!do co( )c(c&o7663- dl&(! $*!do 9

"$!# %&l&!'#


6/17

L! '#(c&! d Ic)'&c&!- !#oc&!do ! %' #)!'$! 'l!c&o(!do ! u(!col!(*&) o' coldocol&)&!# o o' ;$#)ul! colc)o7coldoc&!(!=#$(d'o3 d M&'&&?

V. DIAGNO%"ICO DIFERENCIAL Apendicitis aguda: E( !c&()# :"(# l dolo' #)!' 3#

'o%!%l3() c!u#!do o' !(d&c&) =loc!l&!c&:( #u%)&c!?-3&()'!# u ( l !(c&!(o # 3# 'o%!%l l! colc)&)

D#&! #&3l ( !c&()# :"(#- co( !()cd()#- ud('oduc&'# !*ud&!c&o(#- ( oc!#&o(# 3u9 d&cul)o#!# dd&;'(c&!' d u(! colc)&) Ll*!( !l o#&)!l co( u( !#c)o d3(o' !;c)!c&:( 9 u( dolo' 3(o# &()(#o- # dc&'- (o&3'#&o(! (;'3d!d *'!"- ! d&;'(c&! d lo# !;c)!do# dcolc)&) L!# d#&!#- #ul( 'oduc&' dolo' d&;u#o- (o

loc!l&!do- 9 cu!(do #) # loc!l&! # 3# ;'cu() (&*!#)'&o- #&(do l! !l!c&:( dolo'o#! d ;o'3! (o loc!l&!d!- lc'! duod(!l ()'!() o ';o'!d! lc'! *#)'&c! !*ud! o ';o'!d! P!(c'!)&) !*ud! co( l! cl$(&c! (o # o#&%l d&;'(c&!' ()'

!3%o# 'oc#o# L! '#(c&! d &'!3&l!#3&! o'&()! ld&!*(o#)&co !c&! l! !(c'!)&)

S &(clu9( (;'3d!d# u c!u#!( dolo' o' !u3()o '&dodl "olu3( dl $*!do o o' &(!3!c&:( )&c!- co3o!)&)- !)&) !lco:l&c! !*ud!- &(#uc&(c&! c!'d&!c!d'c!- ()' o)'!#

VI. MANE3O %EG4N NIVEL DE COM5LE3IDAD Y CA5ACIDADRE%OLU"IVA.

Todo !c&() co( u( cu!d'o cl$(&co #u*#)&"o d Colc)&) A*ud!"!lu!do o' l C&'u!(o A#)() o R#&d() d >' !@o- d%' #'o#&)!l&!do,. 5LAN DE "RABA3O

a. "era)6utica NPO =N!d! o' V$! O'!l? H&d'!)!c&:( (do"(o#!, Clo'u'o d #od&o !l 068 d !cu'do !l

#)!do d &d'!)!c&:( 9 c!!c&d!d c!'d&o"!#cul!' C!3%&!' !D


7/17

U#o d A(!l*#&co# A()&&(!3!)o'&o# !#oc&!do# !!()!#3:d&co#, .)o'ol!co >070 3* EV cQ/ o M)!3&ol 1* EVcQ/ o D&clo;(!co 5 3* EV cQ/ &o#c&(! 10 3* EV cQ/

El u#o d !()&%&:)$co)'!&! 'olc)&c! #) 'co3(d!do !'!'"(&' l!# &(;cc&o(# o#)o'!)o'&!# ( l!# colc$#)c)o3$!#

lc)&"!# D&!*(o#)&c!d! l! Colc)&) A*ud! L&)&!#&c!- l !()&%&:)&co d

lccc&o( # l! C;!ol&(! 1 *' EV cQ/

U#o d #o(d! (!#o*#)'&c! ( c!#o d ":3&)o# o d)(#&:(!%do3&(!l 9 d #o(d! "#&c!l ( c!#o d co3'o3o3od&(3&co

El u#o d "(d! l#)&co d 3&3%'o# &(;'&o'# # o%l&*!)o'&o (!c&()# 3!9o'# d 0 !@o# 9 o%#o# !()# dl &(*'#o ! SOP

P'o)cc&:( *#)'&c! "()u!l #*B( #$()o3!# *#)'&co# !#oc&!do# 9co3o'%&l&d!d co( R!(&)&d&(! 50 3* E" cQ/ u O3'!ol 03* E"cQ2

U#o d A()&3)&co# co3o 3)oclo'!3&d! 10 ! >0 3* EV cQ/co(d&c&o(!l ! ":3&)o#

&. E7!8e(es Au7iliares Eco*'!;$! A%do3&(!l

To3o*'!;$! A%do3( Su'&o' =E( dud! D&!*(o#)&c! oco3o'%&l&d!d#?

H3o*'!3! 9 3!)oc'&)o- Gluco#! U'! 9 C'!)&(&(!

A3&l!#! #'&c!

4&l&''u%&(!#- o#;!)!#! Alc!l&(! 9Qo G!33! Glu)!3&lT'!(#)&d!#!

E

R!d&o*'!;$! d ):'! P&l, N9lo( >Q0 Pu()o# S!'!do# o #u%cu)&cul!'#-

COLEC#%"I"I% AGUDA ; 5ERI"ONI"I% LOCALI P'&)o(o, Ac&do Pol&*l&c:l&co 0 Pu()o# Co()&(uo#> Ao(u'o#, Ac&do Pol&*l&c:l&co I Pu()o# S!'!do# " C'u!do#-


10/17

> I''&*!c&:( ! '#&:( co( #u'o #&ol:*&co lu*o dl c&'' dF'&)o(o 9 !o(u'o#

> P&l 9 TCSC # d!( !%&')!# !'! u( c&'' '&3!'&o d&;'&dod#u# d : 5 d$!# =E( c!#o# #lcc&o(!do# ud '!l&!'# u(c&'' '&3!'&o d &l?-

COLECI%"I"I% AGUDA ; 5ERI"ONI"I% GENERALICNICA ?UIR4RGICA:K U%&c!c&:( d lo# )'oc!'# ,Tc(&c! A3'&c!(! 9 Tc(&c! A3'&c!(! Mod&c!d!=o#&c&:( dcB%&)o#u&(o 9 &'(!# *!d!#?= o#&c&:( dcB%&)o #u&(o 9 &'(!# !%&')!#?TI, =10 33? o3%l&*o o T2, =10 33? &*#)'&co o T>, 5 33?&oco(d'&o d'co o T, =5 33? !(co d'co

Tc(&c! '!(c#! =o#&c&:( dcB%&)o #u&(o %'!o# *!do#-&'(!##!'!d!#?o TI, =lO33? o3%l&*oo T2, =5 33? &*#)'&coo T>, =10 33-? !(co &u&'doo T, =5 33? !(co d'co


11/17

Nu3o'&)o(o ()' 127 133H* P!c&() ( o#&c&:( #u&(! ( ol' 9 l!)'!l&!do ! l! &u&'d! E


12/17

l! "#$cul! *u&!do o' ECO Q TAC u)&l&!(do !(#)#&! loc!l o' R!d&olo*$!I()'"(c&o()! co( '#(c&! dl C&'u!(o@. LUGAR Y FORMA DE A"ENCINa. Ma(eo )reo)eratorio: E( l #'"&c&o d 3'*(c&!, '! do%#'"!c&:( o

( l!# d&;'()# #'"&c&o# d o#&)!l&!c&:(% 5rocei8ie(to uirrgico: E( #!l! d o'!c&o(#c 5ostO)eratorio: E( l #'"&c&o d C&'u*$! ( c!#o u 'u&'!3o(&)o'o 9 3!(o &()(#&"o # )'!#l!d!' ! l!# u(&d!d# d Cu&d!do#&()(#&"o# CI- UCI o SOC T'!u3! #ocd%egui8ie(to A8&ulatorio: E( l co(#ul)o'&o


13/17

'o)!d! ! "$! o'!l co( c;!l

Mo"&l&!c&:( 'co dl d'( l!3&(!' ( PO1 =!'! W'o3'W l)!:( d %'&(!? 9 ( ;o'3! !ul!)&(! ! !')&' dl P0> !#)! #u')&'o d(&)&"o- Q0CON%IDERACIONE% E%5ECIALE%

! Cu!(do l !c&() co( d&!*(:#)&co d Colc)&) A*ud! cu'#! co(s*ocs6)tico +o is0u(ci9( org!(ica agua$ #' 3!(!do ( CI- UCI oSoc T'!u3!- co( l! (!l&d!d d d!' !o9o 3od&(3&co- "()$l!)o'&o-u&do)'!&!- !()&%&:)&co)'!&! d !3l&o #c)'o- &(o)':&co#- )c (u( &()()o o' 3o'!' 9 co3(#!' #u co(d&c&:( cl$(&c! '"&! ! l!!cc&:( u&'B'*&c!% Lo# !c&()# co( cu!d'o o'&do d Colc)&) A*ud! 9 co(P!(c'!)&)A*ud! co(cu''() u '#)! co( #&*(o# d ## d%( #'#o3)&do# !colc)c)o3&! d 3'*(c&!c E( c!#o d !#oc&!'# u(! coldocol)&&!# co( col!(*&) o ;$#)ul!%&l&!'- #)o#'o%l3!# d%( d #oluc&o(!'# d(&)&"!3() u(! " '!l&!d! l!colc)c)o3$!CRI"ERIO% DE AL"Aa. COLECI%"I"I% AGUDA NO COM5LICADAE( colc)c)o3$!# co("(c&o(!l#- !c&() !;%'&l- co( %u(!

)ol'!(c&! o'!l- #&( &c)'&c&!- '&d! o'!)o'&! ( %u(!# co(d&c&o(#-co( dolo' o#)o'!)o'&o 3$(&3o Al)! ! l!# / X 2 o'!#E( c!#o d Colc$#)c)o3$! l!!'o#c:&c!- !l)! ! l!# 2 o'!# S udco(#&d'!' !l)! 'co ( c!#o# #lcc&o(!do# %!o &(d&c!c&:( dlc&'u!(o&. COLECI%"I"I% AGUDA COM5LICADA


14/17

P!c&() !;%'&l : )3'!)u'! 3(o' : &*u!l ! >/YC o' / o'!#-)ol'!(do d&)! %l!(d!- co( dolo' o#)o'!)o'&o 3$(&3o- #&( &c)'&c&!-'&d! o'!)o'&! ( %u(!# co(d&c&o(# : &(;cc&:( 3$(&3! co()'ol!d!-#&( d'( &()'!7!%do3&(!l Al)! ()' l >'75)o d$! o#)7o'!)o'&o-#*B( "oluc&:( cl$(&c! o &(d&c!c&:( dl c&'u!(o

El !c&() d%' #!l&' co( &(d&c!c&o(# 3d&c!# #c'&)!#- d!d!# o' l3d&co R#&d() )'!)!() do(d *u', l! d&)!- lo# !()&%&:)&co# 9!(!l*#&co# ! 'c&%&' #c&c!(do l! c!()&d!d 9 l o'!'&o ! 3l!'-!d3# d% &(clu&'# lo# #&*(o# d !l!'3! ! )(' '#() D%' #'c&)!do !l co(#ul)o'&o


15/17

1 4!'!co G4Col!(*&o*'!;$! o'!)o'&! 9 c&'u*$! %&l&!' 4olAcPc'C&'16501557>

2 4!'%o! E-Dl C!#)&llo M4&l&%!c)c'&!,#&*(&c!do cl$(&co ( c&'u*$! %&l&!D&!*(o#)&c:lF 16/-

> 4!'%o! E Dl C!#)&llo M A%#c#o Su%;'(&co I Co(*'#o P'u!(o d [

C&'u*$! 16/

4!'%o! 4E Colc)&) !*ud!, I()'"(c&:( )3'!(! T# Doc)o'!l-UPC16

5 \o)uo EGu''!L E#)ud&o d lo# 'oc#o# %&l&!'# %(&*(o# UPCH7Co3u(&c!c&:( '#o(!l Ho#&)!l C!9)!(o H'd&! 16

Edu!'do 4!'%o! O#!' V&d!'$ Ed*!' NB@, L! C&'u*$! T3'!(! (Colc)&) A*ud! 165716/7R")! d l! Soc&d!d d C&'u!(o#G('!l#

A##!\! A- .ol3!( D- H!#3o(!$ M3'*(c9 3&(&l!!'o)o39colc9#)c)o39 )'&!l7&3l&c!)&o(# ;o' ) l!!'o#co&c '! ]o'ld ^ Su'*

166,21,>75>6

/ 4&(*(' ^R&c!'d# ML- S#&(*' ]H- ) !l L!!'o#co&ccolc)c)o39 ;o' ld'l9 !)&()#, *old #)!(d!'d ;o' *old( 9!'#_ A'cSu'* 200> 1>/,5>17555

6 H#$c CHE!'l9 3&(&l!!'o#co&c colc9#)c)o39 &( !)&()# &) !culcolc9#)&)A3 Su'* 200> 1/5,>7>/

10.&"&luo)o T S&'( ^- Luuo(( P- ) !l 7R!(do3d )'&!F o; l!!'o#co&c ["'#u# o( colc9#)c)o39 ;o' !cul !(d *!(*'(ou# colc9#)&) L!(1[ 166/>1>51>2$7>25

11L!& P4- .o(* .H(Lu(* .L- .o SP- ) !; R!(do'(&d I'&!$ o; !'lQ "'#u#dl!9cd l!!'o#co&c colc9#)c)o39 ;o' !cu) colc9#)&)' ^ Su'*166//5,7

12N!'old DL Acu) colc)&) E( T


16/17

Sb !@o# Ru C&l C&' 166 6, 15>71520I(d!' AA Acu) Co&cc)&) 4M^ 2002 >25,>67>

21N!% A- Co3u& A*- M!')$( L- So(((%'* CE- S!')74!#&lc D- .#%!AI1 ) !l G!ll#)o(#, *()&c# "'#u# ("&'o(3() A(( Su'* 2 702[ /27/6

22P!& C- C!)!'c& M- D7A3%'o#&o L- G&l& L- .oc M- C&'!# C&4 c) !l T&3&&* o;colc)&), ! 3)!7!(!l9# A3 ^ G!#;,176-

24'!(u3 G- Sc3&)) C- 4!&ll& ^- Suoc& P- 4!' M- D!"&do A ) !l-M!(!*3() o; 3!o' %&l$!'9 co3l&c!)&o(# !;)' l!!'o#co&ccolc9#)c)o39 Au( Su'* 166>21,5>2750 dcu##&o( 5075L

25M)c!l; MS - O(* T- 4'u(&(* MH- I#!'&! - ]39##7Hold( SA-M!dd'( G^ T# l!!'o#co&c &()'!o'!)&" col!(*$o*'!3 ! 3!))' o;'ou)&(_ A3 ^ Su'* 200 1/,57/1

2Cu#c&'& A- C'oc E;!**&o(& A- ^!&3o&c ^- L!c9 A- Loc E ) !l EAESduc)!l #)o( #)ud9 P'l&3&(!'9 (d&(*# o; 3ul)&7c()' 'o#c)&"'!(do3d )'&!l co3!'&(* )o7#)!* "# #&(*l7#)!* 3!(!*3() Su'*E(do# 166 10,11>01>5

2U'%!c DR.!!(c eS- ^o% 4A- S)!(d!* 4A- H!(#( PD- S!(#)'o3LL Co#)7;$c)&" 3!(!*3() o; co33o( %&l duc) #)o(#, ! dc&:(!(!l9# o; ) u# o; (do#co&c ')'o*'!d col!(*&o!(c'c!)o*'!;9=ERCP?- &()'!o'!)&" col!(*&o*'!9- !(d l!!'o#co&c %&l duc)

2/Dl C!#)&llo M Colc)&) !*ud! , )c(&c! co("(c&o(!l "# l!!'o#c:&c!-

#)ud&o co3!'!)&"o=)# doc)o'!do ( 3d&c&(!? L&3!- P'B,U(&"'#&d!dP'u!(! C!9)!(o H'd&!7E#cul! d o#)*'!do V$c)o' Al!3o'! C!#)'o-166Q5

26U'&ol R L)!l&d!d o#)o'!)o'&! d l! (;'3d!d l$)&!#&c! %&l&!', &(c&d(c&!9 'o%!%l# ;!c)o'# d '*o HNCH16/71660 =)# l&c(c&!do (3d&c&(!? L&3!- P'B, U(&"'#&d!d P'u!(! C!9)!(o H'd&!- 1662-5>

>0C!%!ll'o RCo)c)c)o3$! L!!'o#c:&c! ( l HNHC 1667166/=)# d%!c&ll' ( Md&c&(!? L&3!- P'B,U(&"'#&d!d P'u!(! C!9)!(o H'd&!-1666

>1V!ld&"&! E- C&'u*$! L!!'o#c:&c!, "!lu!c&:( d l!# '&3'!# 200

colc)c)o3$!# l!!'o#c:&c!# ( l Ho#&)!l Ed*!'do R%!*l&!)& M!')&(!=T# d 4!c&ll' ( Md&c&(! ?L$3!- P'B, U(&"'#&d!d P'u!(! C!9)!(oH'd&!- 166

>24!u))! ^- ) !l C&'u*$! L!!'o#c:&c! ( l S'"&c&o d C&'u*$! G('!l NY dl Ho#&)!l N!c&o(!l Gu&ll'3o Al3(!'! T'&*o9( R" Md IPSS 166>2=?

>>S!l!!' Cu'"!# d A'(d&! ( Colc)c)o3$! LAPAROSCaPICA, U(A(l d 00 c!#o#- =T# d 4!ll&c' ( Md&c&(! ? L&3!- P'B,U(&"'#&d!d P'u!(! C!9)!(o H'd&!- 1666


17/17

>.u3 C.- Go PMe- I#!!c ^R- ) !l L!!'o#co&c colc9#)c)o39 ;o' !cu)colc9#)&) 4' ^ Su'* 166 /1,151715

>5L!'!c ^ M!(o d l! Coldocol&)&!# du'!() l! colc)c)o3$!LAPAROSCaPICA R" Md H'd 166>=2?,/>7S

>4!'!cco V L! Col)c)o3&! LAPAROSCaPICA E/D'"o*lou A- T#&od'!# S- ) !l T V!lu o; C3o'o9l!

Guia de Colecistitis Aguda Modif Ultra

Documents

Transcript of Guia de Colecistitis Aguda Modif Ultra