Cholelithiasis (Gallstones)

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Last reviewed: 17 Aug 2025
Last updated: 14 Aug 2025

Summary

Definição

História e exame físico

Principais fatores diagnósticos

  • right upper quadrant (RUQ) or epigastric pain (lasting >30 minutes)
Detalhes completos

Outros fatores diagnósticos

  • postprandial pain
  • RUQ or epigastric tenderness
  • nausea
  • jaundice
Detalhes completos

Fatores de risco

  • increasing age
  • female sex
  • Hispanic and American Indian ethnicity
  • family history of gallstones
  • gene mutations
  • elevated estrogen and progesterone levels
  • obesity, diabetes, and metabolic syndrome
  • nonalcoholic fatty liver disease
  • prolonged fasting/rapid weight loss
  • total parenteral nutrition (TPN)
  • use of octreotide
  • use of glucagon-like peptide-1 (GLP-1) receptor agonists
  • use of ceftriaxone
  • terminal ileum disease or resection
  • hemoglobinopathy
  • cirrhosis
  • cystic fibrosis
  • diet and lifestyle
  • helicobacter pylori gallbladder infection
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • abdominal ultrasound
  • serum liver function tests
  • CBC
  • serum lipase or amylase
Detalhes completos

Investigações a serem consideradas

  • magnetic resonance cholangiopancreatography (MRCP)
  • endoscopic ultrasound scan (EUS)
  • endoscopic retrograde cholangiopancreatography (ERCP)
  • abdominal CT scan
Detalhes completos

Algoritmo de tratamento

AGUDA

symptomatic cholelithiasis

choledocholithiasis with or without symptoms

CONTÍNUA

asymptomatic cholelithiasis

Colaboradores

Consultores especialistas

Eldon Shaffer, MD, FRCPC

Emeritus Professor of Medicine

Division of Gastroenterology

University of Calgary

Calgary

Canada

Declarações

ES is an author of several references cited in this topic.

Agradecimentos

Professor Eldon Shaffer would like to gratefully acknowledge Dr Vikesh K. Singh and Dr Anthony N. Kalloo, previous contributors to this topic.

Declarações

VKS and ANK declare that they have no competing interests.

Revisores

Timothy B. Gardner, MD

Assistant Professor

Director of Pancreatic Disorders

Section of Gastroenterology

Dartmouth-Hitchcock Medical Center

Lebanon

NH

Declarações

TBG declares that he has no competing interests.

Ajith Siriwardena, MD, FRCS

Professor of Hepatobiliary Surgery

Manchester Royal Infirmary

Manchester

UK

Declarações

AS declares that he has no competing interests.

Kurinchi Gurusamy, MBBS, MS, MRCS, MSc

Clinical Research Fellow

Hepatopancreatobiliary and Liver Transplant Surgery

University Department of Surgery

Royal Free Campus

UCL Medical School

London

UK

Declarações

KG 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.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

European Association for the Study of the Liver (EASL). EASL clinical practice guidelines on the prevention, diagnosis and treatment of gallstones. J Hepatol. 2016 Jul;65(1):146-81.Texto completo  Resumo

ASGE Standards of Practice Committee; Buxbaum JL, Abbas Fehmi SM, Sultan S, et al. ASGE guideline on the role of endoscopy in the evaluation and management of choledocholithiasis. Gastrointest Endosc. 2019 Jun;89(6):1075-105;e15.Texto completo  Resumo

Tazuma S, Unno M, Igarashi Y, et al. Evidence-based clinical practice guidelines for cholelithiasis 2016. J Gastroenterol. 2017 Mar;52(3):276-300.Texto completo  Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
  • Cholelithiasis (Gallstones) images
  • Diagnósticos diferenciais

    • Acalculous cholecystitis
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  • Diretrizes

    • ACR appropriateness criteria: right upper quadrant pain
    • 2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis
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  • Folhetos informativos para os pacientes

    Gallstones

    Gallstones: questions to ask your doctor

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