Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- dor epigástrica ou no quadrante superior direito (com duração >30 minutos)
Other diagnostic factors
- dor pós-prandial
- sensibilidade epigástrica ou no quadrante superior direito do abdome
- náuseas
- icterícia
Risk factors
- idade mais avançada
- sexo feminino
- Etnia hispânica e indígena norte-americana
- história familiar de cálculos biliares
- mutações genéticas
- estrogênio e progesterona
- obesidade, diabetes e síndrome metabólica
- doença hepática não alcoólica
- jejum prolongado/perda de peso rápida
- nutrição parenteral total (NPT)
- octreotida
- análogos de peptídeos semelhantes ao glucagon 1 (GLP-1)
- ceftriaxona
- doença ou ressecção do íleo terminal
- hemoglobinopatia
- cirrose
- fibrose cística
- dieta e estilo de vida
- infecção da vesícula biliar por Helicobacter pylori
Diagnostic investigations
1st investigations to order
- ultrassonografia abdominal
- testes séricos da função hepática
- Hemograma completo
- lipase e amilase séricas
Investigations to consider
- colangiopancreatografia por ressonância magnética (CPRM)
- USE
- colangiopancreatografia retrógrada endoscópica (CPRE)
- tomografia computadorizada (TC) abdominal
Treatment algorithm
colelitíase sintomática
coledocolitíase com ou sem sintomas
colelitíase assintomática
Contributors
Authors
Eldon Shaffer, MD, FRCPC
Emeritus Professor of Medicine
Division of Gastroenterology
University of Calgary
Calgary
Canada
Disclosures
ES is an author of several references cited in this topic.
Acknowledgements
Professor Eldon Shaffer would like to gratefully acknowledge Dr Vikesh K. Singh and Dr Anthony N. Kalloo, previous contributors to this topic.
Disclosures
VKS and ANK declare that they have no competing interests.
Peer reviewers
Timothy B. Gardner, MD
Assistant Professor
Director of Pancreatic Disorders
Section of Gastroenterology
Dartmouth-Hitchcock Medical Center
Lebanon
NH
Disclosures
TBG declares that he has no competing interests.
Ajith Siriwardena, MD, FRCS
Professor of Hepatobiliary Surgery
Manchester Royal Infirmary
Manchester
UK
Disclosures
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
Disclosures
KG declares that he has no competing interests.
References
Key articles
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.Full text Abstract
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.Full text Abstract
Tazuma S, Unno M, Igarashi Y, et al. Evidence-based clinical practice guidelines for cholelithiasis 2016. J Gastroenterol. 2017 Mar;52(3):276-300.Full text Abstract
Reference articles
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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