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 >50 anos
- 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 relacionada à IgG4
Diagnostic investigations
1st investigations 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
Investigations to consider
- tomografia computadorizada (TC) do abdome com contraste intravenoso
- colangiopancreatografia retrógrada endoscópica (CPRE)
- colangiopancreatografia por ressonância magnética (CPRM)
- colangiografia trans-hepática percutânea (CTP)
- ultrassonografia endoscópica (USE)
Treatment algorithm
agudamente doente
com coledocolitíase, colangite esclerosante primária ou colangiopatia por vírus da imunodeficiência humana (HIV)
Contributors
Expert advisers
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.
Acknowledgements
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.
Revisores
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 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
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
Declarações
BE declares that he has no competing interests.
Créditos aos pareceristas
Os tópicos do BMJ Best Practice são constantemente atualizados, seguindo os desenvolvimentos das evidências e das diretrizes. Os pareceristas aqui listados revisaram o conteúdo pelo menos uma vez durante a história do tópico.
Declarações
As afiliações e declarações dos pareceristas referem--se ao momento da revisão.
Referências
Principais artigos
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.Texto completo Resumo
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.Texto completo Resumo
National Institute for Health and Care Excellence. Gallstone disease: diagnosis and management. October 2014 [internet publication].Texto completo
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.Texto completo Resumo
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.Texto completo Resumo
Artigos de referência
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Colecistite aguda
- Úlcera péptica
- Pancreatite aguda
More DifferentialsGuidelines
- ACG clinical guideline: diagnosis and management of biliary strictures
- ASGE guideline on the management of cholangitis
More GuidelinesVideos
Venopunção e flebotomia – Vídeo de demonstração
Canulação venosa periférica – Vídeo de demonstração
More videosPatient information
Cálculos biliares
More Patient information
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