小结
定义
病史和体格检查
关键诊断因素
- dor epigástrica ou no quadrante superior direito do abdome (com duração >30 minutos)
其他诊断因素
- dor pós-prandial
- sensibilidade no quadrante superior direito ou sensibilidade epigástrica
- náuseas
- icterícia
危险因素
- idade mais avançada
- sexo feminino
- Etnia hispânica e indígena norte-americana
- história familiar de cálculos biliares
- mutações genéticas
- níveis elevados de estrogênio e progesterona
- obesidade, diabetes e síndrome metabólica
- doença hepática gordurosa não alcoólica
- jejum prolongado/perda de peso rápida
- nutrição parenteral total
- uso de octreotida
- uso de agonistas do receptor de peptídeo semelhante ao glucagon 1 (GLP-1)
- uso de ceftriaxona
- doença ou ressecção do íleo terminal
- hemoglobinopatia
- cirrose
- fibrose cística
- dieta e estilo de vida
- tabagismo
- infecção da vesícula biliar por Helicobacter pylori
诊断性检查
首要检查
- ultrassonografia abdominal
- testes séricos da função hepática
- Hemograma completo
- lipase e amilase séricas
需考虑的检查
- colangiopancreatografia por ressonância magnética
- ultrassonografia endoscópica
- colangiopancreatografia retrógrada endoscópica
- tomografia computadorizada (TC) abdominal
治疗流程
colelitíase sintomática
coledocolitíase com ou sem sintomas
colelitíase assintomática
撰稿人
作者
Eldon Shaffer, MD, FRCPC
Emeritus Professor of Medicine
Division of Gastroenterology
University of Calgary
Calgary
Canada
利益声明
ES declares that he has no competing interests.
鸣谢
Professor Eldon Shaffer would like to gratefully acknowledge Dr Vikesh K. Singh and Dr Anthony N. Kalloo, previous contributors to this topic.
利益声明
VKS and ANK declare that they have no competing interests.
同行评议者
Timothy B. Gardner, MD
Assistant Professor
Director of Pancreatic Disorders
Section of Gastroenterology
Dartmouth-Hitchcock Medical Center
Lebanon
NH
利益声明
TBG declares that he has no competing interests.
Ajith Siriwardena, MD, FRCS
Professor of Hepatobiliary Surgery
Manchester Royal Infirmary
Manchester
UK
利益声明
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
利益声明
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.
参考文献
关键文献
European Association for the Study of the Liver. EASL clinical practice guidelines on the prevention, diagnosis and treatment of gallstones. J Hepatol. 2016 Jul;65(1):146-81.全文 摘要
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.全文 摘要
Fujita N, Yasuda I, Endo I, et al. Evidence-based clinical practice guidelines for cholelithiasis 2021. J Gastroenterol. 2023 Sep;58(9):801-33.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.
鉴别诊断
- Colecistite acalculosa
- Pancreatite aguda não biliar
- Úlcera péptica (UP)
更多 鉴别诊断指南
- Evidence-based clinical practice guidelines for cholelithiasis 2021
- ACR appropriateness criteria: right upper quadrant pain
更多 指南患者教育信息
Cálculos biliares
Cálculos biliares: perguntas a fazer ao seu médico
更多 患者教育信息
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