Revisión de Tokio Guidelines 2013

1. Litiasis Biliar
Diego Sierra B. M.D
Cirujano General
Clinica Universidad de la Sabana
Clinica Partenon
@diegosierrab

2. Historia
Ebbell, B. The papyrus Ebers. The greatest Egyptian Medical document.
Copenhagen, Levin & Munksgaard, 1937
Historia

3. Historia
Carl August Langenbuch (1882)
Ohage J. ( 1887) The surgical treatment of diseases of
the gallbladder. Med. News 50, 202-6.

4. Historia
Eric Mühe (1985)
JSLS. 1998 Oct-Dec; 2(4): 341–346.

5. Historia

6. Epidemiologia
Gastroenterol Clin N Am 39 (2010) 157–169

7. Fisiologia
Ganong FG. Fisiologia Medica 17 Ed, pag.561

8. Fisiologia
Calculos
Biliares
Colesterol
-Mas prevalentes
en occidente.
-15%
Radiopacos.
Pigmentos Marrones
-Bilirrubinato y palmitato
calcico.
-Bacterias 90%
-Radiolucidos
-Intrahepaticos
-Parasitos orientales.
Pigmentos negros
-20-30%
-Pigmento de
bilirrubina
-No tienen colesterol
-60% radiopacos.
-Hemolisis, cirrosis
biliar
-Composicion alterada
de la bilis.
-Nucleacion de cristales de
colesterol.
-Dismotilidad vesicular.

9. Tokyo Guidelines
2007 - 2013.
Términos y etiologia.
Diagnostico.
Antibióticos.
Clasificación y severidad
Manejo
Journal of Hepato-Biliary-Pancreatic Sciences
Volume 20, Issue 1, January 2013
Colecistitis - Colangitis

10. Journal of Hepato-Biliary-Pancreatic Sciences
Volume 20, Issue 1, January 2013
Sobrecrecimiento bacteriano.
Aumento de la presión en la via biliar.
Colangitis Aguda
Charcot M. De la fievre hepatique symptomatique—
comparaison avec la fievre uroseptique.
Paris: Bourneville et Sevestre;1877. p. 176–185.

11. Journal of Hepato-Biliary-Pancreatic Sciences
Volume 20, Issue 1, January 2013

12. Journal of Hepato-Biliary-Pancreatic Sciences
Volume 20, Issue 1, January 2013

13. Journal of Hepato-Biliary-Pancreatic Sciences
Volume 20, Issue 1, January 2013
Colecistitis edematosa. (2-4 dias)
Colecistitis gangrenosa. (3-5 dias)
Colecistitis supurativa (7-10 dias)
Colecistitis cronica.
Colecistitis aguda.

14. Journal of Hepato-Biliary-Pancreatic Sciences
Volume 20, Issue 1, January 2013

15. Journal of Hepato-Biliary-Pancreatic Sciences
Volume 20, Issue 1, January 2013

16. Ecografia
Journal of Hepato-Biliary-Pancreatic Sciences
Volume 20, Issue 1, January 2013

17. Journal of Hepato-Biliary-Pancreatic Sciences
Volume 20, Issue 1, January 2013

18. Severidad

19. Journal of Hepato-Biliary-Pancreatic Sciences
Volume 20, Issue 1, January 2013

20. Journal of Hepato-Biliary-Pancreatic Sciences
Volume 20, Issue 1, January 2013

21. Antibioticos
Journal of Hepato-Biliary-Pancreatic Sciences
Volume 20, Issue 1, January 2013

22. º
http://www.asge.org/publications/publications.aspx?id=352
Baja 10%
Intermedio 10-50%
Alto >50%

23. Coledocolitiasis
http://www.asge.org/publications/publications.aspx?id=352

24. MRCP Vs EUS
EUS: a meta-analysis of test performance in suspected choledocholithiasis.
Tse F, Liu L, Barkun AN, Armstrong D, Moayyedi P
Gastrointest Endosc. 2008;67(2):235.
A systematic review and evaluation of magnetic resonance cholangiopancreatography
compared with diagnostic endoscopic retrograde cholangiopancreatography.
Kaltenthaler E, Vergel YB, Chilcott J, Thomas S, Blakeborough T, Walters SJ, Bouchier H
Health Technol Assess. 2004;8(10):1.

25. cpre + colelap
Ventajas:
Menor tiempo Hospitalario
No hay aumento de tasa de complicaciones
Complicaciones visualizadas tempranamente
Tecnica de rendezvous.

26. Coledocolitiasis

27. Innovación

28. Gracias
“Todo medico guarda en su corazón un cementerio al que
debe visitar con frecuencia para seguir siendo humilde y
generoso”
A. Paré