Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- dor no quadrante superior direito/dor na parte superior do abdômen
- sensibilidade no quadrante superior direito/na parte superior do abdome
- icterícia
- febre
Other diagnostic factors
- fezes claras
- prurido
- hipotensão
- alterações do estado mental
Risk factors
- Idade mais avançada
- colelitíase
- estenose benigna
- estenose maligna
- lesão do ducto biliar pós-procedimento
- história de colangite esclerosante primária
- história de colangite esclerosante secundária
- Infecção pelo vírus da imunodeficiência humana (HIV)
- inibidores de checkpoints imunológicos
- Doença digestiva relacionada à imunoglobulina (Ig) G4
Diagnostic tests
1st tests to order
- Hemograma completo
- ureia sérica
- creatinina sérica
- Análise da gasometria arterial
- testes séricos da função hepática
- proteína C-reativa
- potássio sérico
- magnésio sérico
- hemoculturas
- painel da coagulação
- ultrassonografia transabdominal
Tests to consider
- colangiopancreatografia retrógrada endoscópica (CPRE)
- tomografia computadorizada (TC) do abdome com contraste intravenoso
- colangiopancreatografia por ressonância magnética (CPRM)
- ultrassonografia endoscópica (USE)
- colangiografia trans-hepática percutânea (CTP)
- abordagens cirúrgicas
Treatment algorithm
agudamente doente
com coledocolitíase, colangite esclerosante primária ou colangiopatia por vírus da imunodeficiência humana (HIV)
Contributors
Authors
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 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.
Acknowledgements
Dr Douglas G. Adler would like to gratefully acknowledge Dr Andrew S. Fedoravicius, a previous contributor to this topic.
Disclosures
ASF declares that he has no competing interests.
Peer reviewers
Christian Macutkiewicz, MD, FHEA, FRCS
Consultant General & Hepato-Pancreato-Biliary (HPB) Surgeon
Manchester Royal Infirmary
Manchester
UK
Disclosures
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
Disclosures
DJH declares that he has no competing interests.
Todd Baron, MD
Professor of Medicine
Division of Gastroenterology & Hepatology
Mayo Clinic Rochester
Rochester
MN
Disclosures
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
Disclosures
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
Disclosures
BE declares that he has no competing interests.
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