Acute cholangitis
Resumo
Definition
História e exame físico
Principais fatores diagnósticos
- right upper quadrant (RUQ)/upper abdominal pain
- RUQ/upper abdominal tenderness
- jaundice
- fever
Outros fatores diagnósticos
- pale stools
- pruritus
- hypotension
- mental status changes
Fatores de risco
- older age
- cholelithiasis
- benign stricture
- malignant stricture
- postprocedure injury of bile ducts
- history of primary sclerosing cholangitis
- history of secondary sclerosing cholangitis
- HIV infection
- use of immune checkpoint inhibitors
- immunoglobulin (Ig) G4-related digestive disease
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- CBC
- serum BUN
- serum creatinine
- blood gas analysis
- serum LFTs
- CRP
- serum potassium
- serum magnesium
- blood cultures
- coagulation panel
- transabdominal ultrasound
Investigações a serem consideradas
- endoscopic retrograde cholangiopancreatography (ERCP)
- abdominal CT scan with intravenous contrast
- magnetic resonance cholangiopancreatography (MRCP)
- endoscopic ultrasonography (EUS)
- surgical approaches
Algoritmo de tratamento
acutely ill
with choledocholithiasis, PSC, or HIV cholangiopathy
Colaboradores
Consultores especialistas
Douglas G. Adler, MD, FACG, AGAF, FASGE
Professor of Medicine
Director, Center for Advanced Therapeutic Endoscopy (CATE)
Porter Adventist Hospital, Centura Health
Denver
CO
Declarações
DGA has provided consulting and speaking services for Abbvie, Boston Scientific Olympus America, and Cook Endoscopy, some of which make products relevant to this topic. He is also an author of references cited in this topic.
Agradecimentos
Dr Douglas G. Adler would like to gratefully acknowledge Dr Andrew S. Fedoravicius, a previous contributor to this topic.
Declarações
ASF declares that he has no competing interests.
Revisores
Christian Macutkiewicz, MD, FHEA, FRCS
Consultant General & Hepato-Pancreato-Biliary (HPB) Surgeon
Manchester Royal Infirmary
Manchester
UK
Declarações
CM declares that he has no competing interests.
David J. Hackam, MD, PhD
Associate Professor of Pediatric Surgery
University of Pittsburgh School of Medicine
Pittsburgh
PA
Declarações
DJH declares that he has no competing interests.
Todd Baron, MD
Professor of Medicine
Division of Gastroenterology & Hepatology
Mayo Clinic Rochester
Rochester
MN
Declarações
TB is an author of a reference cited in this topic.
Dennis Freshwater, MB, BS, MD, FRCP
Consultant Hepatologist
The Liver and Hepatobiliary Unit
Queen Elizabeth Medical Care Unit
University Hospitals Birmingham NHS Foundation Trust
Birmingham
UK
Declarações
DF declares that he has no competing interests.
Bertus Eksteen, MRCP, PhD, MRC
Clinical Scientist
University of Birmingham
Honorary Consultant
Liver Transplant Unit
University Hospitals Birmingham NHS Foundation Trust
Birmingham
UK
利益声明
BE declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
Kiriyama S, Kozaka K, Takada T, et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholangitis (with videos). J Hepatobiliary Pancreat Sci. 2018 Jan;25(1):17-30.全文 摘要
Miura F, Okamoto K, Takada T, et al. Tokyo Guidelines 2018: initial management of acute biliary infection and flowchart for acute cholangitis. J Hepatobiliary Pancreat Sci. 2018 Jan;25(1):31-40.全文 摘要
Gomi H, Solomkin JS, Schlossberg D, et al. Tokyo Guidelines 2018: antimicrobial therapy for acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci. 2018 Jan;25(1):3-16.全文 摘要
Mayumi T, Okamoto K, Takada T, et al. Tokyo Guidelines 2018: management bundles for acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci. 2018 Jan;25(1):96-100.全文 摘要
Mukai S, Itoi T, Baron TH, et al. Indications and techniques of biliary drainage for acute cholangitis in updated Tokyo Guidelines 2018. J Hepatobiliary Pancreat Sci. 2017 Oct;24(10):537-49.全文 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
- Acute cholecystitis
- Peptic ulcer disease
- Acute pancreatitis
更多 鉴别诊断指南
- ACG clinical guideline: diagnosis and management of biliary strictures
- ASGE guideline on the management of cholangitis
更多 指南Videos
Venepuncture and phlebotomy: animated demonstration
Peripheral intravascular catheter: animated demonstration
更多 操作视频患者教育信息
Gallstones
更多 患者教育信息
登录或订阅即可浏览 BMJ Best Practice 临床实践完整内容
内容使用需遵循免责声明