jueves, 27 de septiembre de 2007

DIETOTERAPIA EN VESICULA BILIAR


La vesícula biliar es un órgano pequeño, en forma de pera situado detrás del hígado y adosado a el, mide de 7 a 10 cm de longitud. Su conducto cistico se une al hepático común del hígado para constituir el coledoco que drena hacia el duodeno.

La bilis se compone de:

Ácidos biliares 12 %

Fosfolipidos (lecitina) 4 %

Colesterol 0.7%

Electrolitos (Na, Cl, K, Ca)

Bicarbonato

Mucina (moco) 0.5 %

De color amarillo verdoso

Se produce diariamente 800 a 1000 ml

Función: almacena la bilis producida por el hígado, la bilis interviene en la digestión y absorcion de grasas, vitaminas liposolubles (A,D,E,K) y minerales como hierro y calcio.

Colecistitis : es la inflamación aguda o crónica de la besicula biliar.

Colelitiasis : es la presencia de cálculos en la vesícula biliar la palabra deriva de los terminos CHOLE: significa bolsao vesícula,

LITHOS significa piedra.

Litogenesis: hay alta concentración de los componentes de la bilis (colesterol y sustancias pigmentarías) no se disuelven en la bilis, se precipitan y forman cristales sólidos y los cálculos mas frecuentes son los de colesterol.

Factores de riesgo en ambos padecimientos:

1 Obstrucción del conducto cistico o coledoco por un calculo (Colecistitis aguda)

2 Dieta alta en grasas y colesterol

3 Obesidad excesiva

4 Sedentarismo

5 Predisposición genética

6 Sexo femenino.

7 Hormonal ( estrogenos ) metabolismo colesterol

8 embarazo (multipariedad)

9 hipercolesterolemia

10 hiperlipidemia (lípidos sericos elevados en sangre)

11 infeccioso (bacterias)

Cuadro clínico.

Cuando un calculo obstruye el sistema biliar ( conducto cistico o coledoco) presencia de un cólico biliar siempre inicia 2 o 3 horas después de una comida excesiva o altas en grasas con una sensación de distensión epigastrica o dificultad retroxifoidea, se trasforma de dolor de intensidad creciente, continuo ubicado en el epigastrio e hipocondrio derecho, se irradia al dorso derecho. Se acompaña de nauseas vomito se presenta al comienzo del cólico, este episodio de cólico siempre dura 15 a 20 horas y crece gradualmente en forma espontanea.

El cólico complicado es mas prolongado de varias horas o días, solo cede parcial y transitoria a los analgésicos. Se acompaña de vómitos intensos, escalofríos, fiebre de 39 grados, ictericia, el dolor ocupa todo el emiabdomen derecho.

Comúnmente se piensa que los cólicos biliares aparecen después de comidas abundantes y muy ricas en grasas y colesterol constituyen un estimulo para la liberación de la hormona COLECISTOCININA.

Diagnostico


Clínico interrogatorio, exploración física, sensibilidad a la palpación, en la área hepática.

Laboratorio determinación de bilirrubina, enzimas hepáticas

Gabinete ultrasonido de hígado y vías biliares, RX simple o medio de contraste colecistografia, ecografía contenido de liquido vesicular
Manejo o tratamiento

Dietoterapia: dieta blanda de poco residuo o general

De fácil digestión y absorción

VCE normal o de reducción (obesidad)

FDS H de carbono, proteínas, lípidos: hipograsa utilizar grasa insaturadas (ácidos grasos omega 3) , baja en c colesterol, sin alimentos colecistoquineticos.

Los alimentos colecistoquineticos estimula la hormona colecistoquinina y estimulan la contracción de la vesícula biliar y relajación del esfínter de Oddi.

Alimentos colecistoquineticos: crema, mantequilla, manteca, tocino, frituras, vísceras, hígado, chorizo, longaniza, quesos grasosos (amarillo, manchego, chihuahua, crema y doble crema) mariscos, yema de huevo, leche entera, carne de cerdo sesos, frutas secas grasosas, Carnitas aguacate etc.

Objetivos de la dietoterapia:


Mantener el reposo la vesícula biliar

Estimular suavemente la secreción de la bilis con una dieta baja en grasas y sin alimentos colecistoquineticos

Reducir el peso del paciente en caso de obesidad

Modificar hábitos dietéticos dieta baja en grasa y sin alimentos colecistoquineticos.

Evitar complicaciones (estenosis vía biliar, litos residuales, impactación del litio en la ampula de Vater, perforación pancreatitis aguda)
Medico: disolución de los litios de colesterol con la administración de ácidos biliares (ac quenodeoxilico duración de 18 meses o mas; lititripsia estracorporea (ondas de choque sonico).

Quirúrgico: colescistectomia, esfinterotomia endoscopia

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