BTI

Biliary Tract Disorders

• 4F: Female, forty, fat, fertile
Gallstone disease • Seringkali asimptomatik
(cholelithiasis) • Simptomatik: biliary colic (terutama stlh makan
berlemak) pd epigastrium atau RUQ

• Trias dx: Fever, Leukositosis, RUQ Tenderness

• Murphy sign (+)
Acute Cholecystitis • Biliary colic > memburuk secara progresif, radiasi ke
interscapular area, scapula & bahu dextra

• Asymptomatic
Gallstone in CBD • Biliary colic
(choledocholithiasis) • Obstructive jaundice

• Trias Charcot: 1. jaundice, 2. fever, usually with rigors,

Cholangitis 3. RUQ abdominal pain.
• Severe: hypotension, altered mental status

Congenital : Atresia • Cholestasis  jaundice with increase of direct bilirubin

bilier • 80% pd bile duct di atas level porta hepatis
 Gallstone Disease / Cholelithiasis
• Terbentuk di gallbladder. Bisa bermigrasi ke distal : ductus cysticus, ductus
choledocus, ductus pancreaticus atau Ampula vater.
• Tipe :
– 80% cholesterol & mixed stone
– 20% pigmented stone
• Cholesterol & mixed stone
– Konten : kolesterol monohidrat, garam Ca,
bile pigment, protein & fatty acid
– Mekanisme penting : increased biliary secretion of
cholesterol, biasa pada pasien obese atau
diet tinggi kolesterol
• Pigmented stone
– Konten : kalsium bilirubinat (dominan)
– Biasa pd pasien chronic hemolytic disease
atau alcoholic cirrhosis
• Dx :
– Plain film > deteksi radiopaque kalsium (kasus: 10-15% kolesterol & 50%
pigmented stone)
– USG