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最后审阅: 11 Oct 2024
最后更新: 14 Dec 2023

小结

定义

病史和体格检查

关键诊断因素

  • 右上腹疼痛
  • 右上腹压痛
  • 炎症的症状和体征
  • 可触及肿块
  • 存在的危险因素

其他诊断因素

  • 发热/寒战
  • 恶心
  • 右肩痛
  • 厌食
  • 呕吐
  • 黄疸

危险因素

  • 结石
  • 缺乏体力活动
  • 低纤维摄入
  • 严重疾病
  • 创伤
  • 重度烧伤
  • 全胃肠外营养 (TPN)
  • 糖尿病
  • 头孢曲松钠
  • 环孢素
  • 肝动脉栓塞形成
  • 感染

诊断性检查

首要检查

  • 腹部 CT 或 MRI
  • 腹部超声
  • 全血细胞计数 (FBC)
  • C 反应蛋白 (CRP)
  • 胆红素
  • 肝功能检查 (LFT)
  • 血清脂肪酶或者淀粉酶
  • 血培养和/或胆汁培养

需考虑的检查

  • 磁共振胰胆管造影术 (MRCP)
  • 超声内镜 (EUS)

治疗流程

撰稿人

专家顾问

John Abercrombie, FRCS

General and Colorectal Surgeon

Queen's Medical Centre

Nottingham

UK

简介

JA is Clinical Lead for General Surgery, Getting It Right First Time.

利益声明

JA is a member of the Council of The Royal College of Surgeons of England and Clinical Lead for General Surgery, Getting It Right First Time. JA provides expert advice regarding suitability of surgical treatments for Spire Healthcare.

Acknowledgements

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

Charles Bellows MD

Professor of Surgery

University of New Mexico School of Medicine

Albuquerque

NM

利益声明

CB is an author of one study referenced in this topic. CB declares that he has no other competing interests.

同行评议者

Christian Macutkiewicz, MD, FHEA, FRCS

Consultant General and Hepato-Pancreato-Biliary Surgeon

Clinical Lead for Emergency General Surgery, Gastrointestinal Medicine, and Surgery CSU

Manchester Royal Infirmary

Manchester

Director of Scientific Programme

Association of Surgeons of Great Britain and Ireland

UK

利益声明

CM declares that he has no competing interests.

编辑

Emma Quigley

Section Editor, BMJ Best Practice

利益声明

EQ declares that she has no competing interests.

Sue Mayor

Lead Section Editor, BMJ Best Practice

利益声明

SM works as a freelance medical journalist and editor, video editorial director and presenter, and communications trainer. In this capacity, she has been paid, and continues to be paid, by a wide range of organisations for providing these skills on a professional basis. These include: NHS organisations, including NICE, NHS Choices, NHS Kidney Care, and others; publishers and medical education companies, including the BMJ Group, the Lancet group, Medscape, and others; professional organisations, including the British Thoracic Oncology Group, the European Society for Medical Oncology, NCEPOD, and others; charities and patients’ organisations, including the Roy Castle Lung Cancer Foundation and others; pharmaceutical companies, including Bayer, Boehringer Ingelheim, Novartis, and others; and communications agencies, including Publicis, Red Healthcare, and others. She has no stock options or shares in any pharmaceutical or healthcare companies; however, she invests in a personal pension, which may invest in these types of companies. She is managing director of Susan Mayor Limited, the company name under which she provides medical writing and communications services.

Tannaz Aliabadi-Oglesby

Lead Section Editor, BMJ Best Practice

利益声明

TAO declares that she has no competing interests.

Julie Costello

Comorbidities Editor, BMJ Best Practice

利益声明

JC declares that she has no competing interests.

Adam Mitchell

Drug Editor, BMJ Best Practice

利益声明

AM declares that he has no competing interests.

专家顾问:合并症

Martyn Patel, BMBcH, FRCP, MA

Consultant, Older People's Medicine

Norfolk and Norwich University Hospitals

NHS Foundation Trust

Norwich

UK

利益声明

MP is a contributor to the Oxford Textbook of Otolaryngology, Oxford University Press, 2021, having written a chapter about mental capacity law, for which he received no fee. MP is the NHS representative on the board for Norwich Institute for Healthy Ageing (unpaid role). MP has spoken at the International Forum on Quality and Safety in Healthcare, virtual conference in November 2020 for which he received no fee.

Paul Cockwell, PhD, FRCP

Consultant Nephrologist

Queen Elizabeth Hospital Birmingham

Professor of Nephrology (honorary)

University of Birmingham

Birmingham

UK

利益声明

PC is president of UK Kidney Association (UKKA), which is the professional organisation that supports healthcare professionals involved in care for, and research, innovation and education in, kidney disease. UKKA has a broad remit with relationships with multiple partners and includes responsibility for UK Kidney Week, the major educational meeting for UK kidney professionals. PC holds grant funding from Kidney Research UK in areas related to chronic kidney disease, and has recently (within the last 3 years) held grants from the EU, NIHR, and MRC in research in areas related to chronic kidney disease. PC has a non-remunerated research partnership with Boehringer Ingelheim into the epidemiology of chronic kidney disease. PC is author of the BMJ Learning module on chronic kidney disease.

Rajiv Sankaranarayanan, MBBS, FRCP (Lon), FESC, FHFA, PhD

Consultant Cardiologist and Heart Failure Lead

Liverpool University Hospitals NHS Foundation Trust

Liverpool Centre for Cardiovascular Science and NIHR Research Scholar and Honorary Senior Clinical Lecturer

University of Liverpool

Liverpool

UK

利益声明

RS has research grants from the British Heart Foundation, the NIHR, NHSX (Transformation Agency), AstraZeneca, Biotronik, and the University of Liverpool. RS has received speaker fees/honoraria and travel reimbursement for conferences from AstraZeneca, Novartis, Vifor, Medtronic, Biotronik, Pfizer, Daaichi Sankyo, and Boehringer. RS has been appointed to: NHS England PIFU Pathway Committee for Heart Failure (2021); British Society for Heart Failure Digital Pathway, Discharge and Virtual Ward Pathway panels; British Cardiac Society Digital and Communications Committee (2020); NIHR Research Scholar (Feb 2020); Clinical Advisory Board of UK’s patient-led charity Pumping Marvellous (2020); and NHS England HF Virtual Ward committee.

Rachael Evans, MBChB, FRCP (UK), PhD

Associate Professor (Clinical)

University of Leicester

Honorary Consultant Respiratory Physician

Glenfield Hospital

Leicester

UK

利益声明

RAE has given lectures for non-promotional industry-led sessions on long COVID and provided consultancy for GSK, AstraZeneca, Boehringer, and Chiesi, for individual payment and travel expenses totalling <£4000.

Gerry Rayman, MD, FRCP

Consultant Physician and Head of Service

Diabetes and Endocrine Centre and the Diabetes Research Unit

Ipswich Hospitals NHS Trust

Ipswich

UK

利益声明

GR received funding from Novo Nordisk in 2022 to attend the EASD conference. GR undertakes several research projects on behalf of East Suffolk and North Essex NHS Foundation Trust for pharmaceutical companies which are on the NIHR portfolio (he does not receive payment himself for these). GR has received lecture fees from Abbott Diabetes UK and Lilly UK.

Sotiris Posporelis, MD, MRCPsych

Consultant Liaison Neuropsychiatrist

King’s College Hospital

South London and Maudsley NHS Foundation Trust

Honorary Senior Clinical Lecturer

Institute of Psychiatry, Psychology & Neuroscience

King’s College London

London

UK

利益声明

SP declares that he has no competing interests.

Asangaedem Akpan, MPH, FRCP

Consultant Geriatrician

Bunbury Regional Hospital

Western Australia Country Health Service

Bunbury

Western Australia

Visiting Professor

University of Cumbria

Carlisle

Honorary Clinical Associate Professor

University of Liverpool

Liverpool

UK

利益声明

AA has a limited company that is seeking consultancy work offering reviews of healthcare services, facilitation of workshops, advice/review of publications. AA has received honorariums for giving lectures on behalf of Profile Pharma in 2021. AA was invited to be on a panel at the British Society for Heart Failure conference in 2022 with all expenses paid and has been invited to contribute to the European Union geriatric medicine conference (free conference registration) and British Society for Heart Failure conference (accommodation and travel expenses covered) in 2022. AA sat on the National Institute for Health and Care Excellence Quality Standards Committee on urinary tract infections in adults as an expert committee member in 2022 and is Deputy Chair of the British Geriatrics Society England Council and Ageing Specialty Research Lead CRN NWC. AA has received research funding from the Liverpool CCG and Applied Research Collaborative 2021-2022. AA contributed to developing a heart failure pathway tool for the British Society for Heart Failure in 2022. AA sits on advisory committees for the following research studies - VOICE2 (development and testing of communication skills training for hospital healthcare practitioners caring for people living with dementia), SWOP (social work in older people), and CFIN (cognitive frailty interdisciplinary network) 2022 -2023.

Acknowledgement: Professor Sanjay Agrawal

BMJ Best Practice would like to gratefully acknowledge Professor Sanjay Agrawal, National Speciality Advisor for tobacco dependency at NHS England and Chair of Royal College of Physicians tobacco advisory group, for his advice on the comorbidity content for 'current smoker'.

Professor Sanjay Agrawal, MBChB, FRCP

Consultant in Respiratory and Intensive Care Medicine

University Hospitals of Leicester NHS Trust

Leicester

UK

利益声明

SA declares that he has no competing interests.

Acknowledgement: Hamish McAuley

BMJ Best Practice would like to gratefully acknowledge Dr Hamish McAuley for his previous involvement in the creation of comorbidity content relevant to asthma and COPD.

Hamish McAuley, MBBS, BSc, MRCP

Clinical Research Fellow

Specialist Registrar (ST5)

Department of Respiratory Sciences

University of Leicester

Respiratory Biomedical Research Unit

Glenfield Hospital

Leicester

UK

利益声明

HM declares that he has no competing interests.

同行评议:合并症

Martyn Patel, BMBcH, FRCP, MA

Consultant, Older People's Medicine

Norfolk and Norwich University Hospitals

NHS Foundation Trust

Norwich

UK

利益声明

MP is a contributor to the Oxford Textbook of Otolaryngology, Oxford University Press, 2021, having written a chapter about mental capacity law, for which he received no fee. MP is the NHS representative on the board for Norwich Institute for Healthy Ageing (unpaid role). MP has spoken at the International Forum on Quality and Safety in Healthcare, virtual conference in November 2020 for which he received no fee.

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