Colangitis aguda

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最后审阅： 3 Apr 2026
最后更新： 18 Jul 2023

小结

定义

病史和体格检查

关键诊断因素

  • presencia de factores de riesgo
  • dolor en el cuadrante superior derecho (CSD)/dolor abdominal superior
  • sensibilidad a la palpación en el CSD/abdomen superior
  • ictericia
  • fiebre
完整详情

其他诊断因素

  • heces pálidas
  • prurito
  • hipotensión
  • cambios en el estado mental
完整详情

危险因素

  • >50 años de edad
  • colelitiasis
  • estenosis benigna
  • estenosis maligna
  • lesión de los conductos biliares posterior a algún procedimiento
  • antecedentes de colangitis esclerosante primaria
  • antecedentes de colangitis esclerosante secundaria
  • Infección por VIH
  • inhibidores del punto de control inmunológico
  • Enfermedad relacionada con IgG4
完整详情

诊断性检查

首要检查

  • hemograma completo (HC)
  • urea sérica
  • creatinina sérica
  • análisis de gasometría arterial (GSA)
  • pruebas de función hepática (PFH) séricas
  • proteína C-reactiva
  • potasio sérico
  • magnesio sérico
  • hemocultivos
  • perfil de coagulación
  • ecografía de abdomen
完整详情

需考虑的检查

  • tomografía computarizada (TC) abdominal con contraste intravenoso
  • colangiopancreatografía retrógrada endoscópica (CPRE)
  • colangiopancreatografía por resonancia magnética (CPRM)
  • colangiografía transhepática percutánea (CTP)
  • ecoendoscopia
完整详情

治疗流程

急症处理

gravemente enfermo

持续性治疗

con coledocolitiasis, colangitis esclerosante primaria (CEP) o colangiopatía asociada al VIH

撰稿人

专家顾问

Christian Macutkiewicz, MD, FHEA, FRCS

Consultant General & Hepato-Pancreato-Biliary (HPB) Surgeon

Manchester Royal Infirmary

Manchester

UK

利益声明

CM declares that he has no competing interests.

鸣谢

BMJ Best Practice would like to gratefully acknowledge the previous expert contributor, whose work has been retained in parts of the content:

Douglas G. Adler, MD, FACG, AGAF, FASGE

Professor of Medicine

Director

Center for Advanced Therapeutic Endoscopy (CATE)

Porter Adventist Hospital

Centura Health

Denver

CO

Disclosures: DGA has consulted for Boston Scientific, Merit Medical, and Olympus, who make endoscopic retrograde cholangio-pancreatography (ERCP) products, and has also consulted for AbbVie Pharmaceuticals. He is an author of references cited in this topic.

同行评议者

David J. Hackam, MD, PhD

Associate Professor of Pediatric Surgery

University of Pittsburgh School of Medicine

Pittsburgh

PA

利益声明

DJH declares that he has no competing interests.

Todd Baron, MD

Professor of Medicine

Division of Gastroenterology & Hepatology

Mayo Clinic Rochester

Rochester

MN

利益声明

TB declares that he has no competing interests.

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

利益声明

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

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

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

National Institute for Health and Care Excellence. Gallstone disease: diagnosis and management. October 2014 [internet publication].全文

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

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.
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