Electronic Theses and Dissertation

ABSTRAK

Kolesistitis akalkulus akut merupakan suatu kondisi peradangan pada kandung empedu yang terjadi tanpa adanya batu kandung empedu. Pasien critically ill yang dirawat di Intensive Care Unit (ICU) memiliki risiko tinggi mengalami kolesistitis akalkulus akut karena berbagai faktor predisposisi, seperti iskemia epitel kandung empedu, penggunaan ventilasi tekanan positif, nutrisi parenteral serta penggunaan obat-obatan opioid. Penelitian ini merupakan studi observasional dengan desain longitudinal prospektif. Subjek penelitian adalah pasien yang dirawat di Intensive Care Unit (ICU) RSUD dr. Zainoel Abidin Banda Aceh pada periode Juni-Agustus 2025 yang memenuhi kriteria inklusi dan ekslusi. Pemeriksaan sonomorfologi kandung empedu dilakukan pada hari pertama dan ketiga perawatan. Analisis bivariat dianalisis menggunakan uji McNemar, dilanjutkan dengan uji regresi logistik untuk menilai hubungan variabel klinis terhadap perubahan sonomorfologi. Sebanyak 41 subjek diikutsertakan dalam penelitian ini dengan rata-rata usia 52 tahun. Sebanyak 24 pasien (58,5%) menunjukkan perubahan sonomorfologi kandung empedu pada hari ketiga perawatan dibandingkan hari pertama. Aspek sonomorfologi yang menunjukkan perubahan bermakna secara statistik pada hari ketiga adalah penebalan dinding kandung empedu (p = 0,031) dan sludge empedu (p = 0,000). Sementara itu, hydrops kandung empedu menunjukkan signifikansi borderline (p = 0,063). Tidak ditemukan kasus dengan gas intramural dan mucosal peeling. Variabel klinis seperti jenis kelamin, usia, jenis nutrisi, penggunaan opioid, penggunaan ventilator mekanik, leukositosis, hipoalbuminemia dan riwayat diabetes mellitus tidak menunjukkan hubungan bermakna (p > 0,05) dengan perubahan sonomorfologi kandung empedu tersebut. Perubahan sonomorfologi yang bermakna pada pasien critically ill di hari ketiga perawatan ICU adalah terbentuknya sludge empedu dan penebalan dinding kandung empedu. Temuan ini menunjukkan adanya kecenderungan peningkatan kejadian sludge dan penebalan dinding kandung empedu pada pasien critically ill seiring lamanya perawatan di ICU.

Kata Kunci: Kolesistitis Akalkulus Akut, Ultrasonografi, Critically Ill, Intensive Care Unit

ABSTRACT Acute acalculous cholecystitis is an inflammatory condition of the gallbladder that occurs in the absence of gallstones. Critically ill patients admitted to the Intensive Care Unit (ICU) are at high risk of developing acute acalculous cholecystitis due to several predisposing factors, including gallbladder epithelial ischemia, the use of mechanical ventilation, parenteral nutrition and opioid. This study was an observational study with a prospective longitudinal design. The subjects were patients admitted to the ICU of dr. Zainoel Abidin General Hospital, Banda Aceh, during the period of June-August 2025, who met the inclusion and exclusion criteria. Gallbladder sonomorphology was examined on the first and third days of ICU admission. Bivariate analysis was performed using McNemar test, followed by logistic regression analysis to evaluate the association between clinical variables and sonomorphological changes. A total of 41 subjects were included in this study, with a mean age of 52 years. Twenty-four patients (58,5%) showed changes in gallbladder sonomorphology on the third days of ICU care compared to the first day. The sonomorphological aspects that demonstrated statistically significant changes were gallbladder wall thickening (p = 0,031) and gallbladder sludge (p = 0,000). Meanwhile, gallbladder hydrops showed borderline significance (p = 0,063). No cases of intramural gas or mucosal peeling were observed. Clinical variables such as sex, age, type of nutrition, opioid use, mechanical ventilation, leukocytosis, hypoalbuminemia, and diabetes mellitus history did not show significant associations (p > 0,05) with gallbladder sonomorphological changes. Significant sonomorphological changes observed in critically ill patients on the third day of ICU admission were the presence of gallbladder sludge and wall thickening. These findings indicate a tendency for increased occurrence of wall thickening and gallbladder sludge among critically ill patients with longer durations of ICU stay. Keywords: Acute acalculous cholecystitis, ultrasonography, critically ill, Intensive Care Unit