小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 右上象限 (RUQ)疼痛/上腹痛
- 右上腹/上腹压痛
- 黄疸
- 发热
其他诊断因素
- 陶土色便
- 瘙痒
- 低血压
- 精神状态改变
危险因素
- 50 岁以上
- 胆石症
- 良性狭窄
- 恶性狭窄
- 胆道术后损伤
- 原发性硬化性胆管炎病史
- 继发性硬化性胆管炎病史
- HIV 感染
诊断性检查
首要检查
- 全血细胞计数（FBC）
- 血清尿素
- 血清肌酐
- 动脉血气 (ABG) 分析
- 血清肝功能检查
- C 反应蛋白 (CRP)
- 血钾
- 血清镁
- 血液培养
- 凝血检查组合
- 内镜逆行胰胆管造影术 (ERCP)
- 经腹超声
需考虑的检查
- 使用静脉造影剂的腹部增强 CT
- 磁共振胰胆管造影术 (MRCP)
- 经皮经肝穿刺胆道造影 (PTC)
- 外科开腹行胆总管探查
新兴检查
- 超声内镜 (EUS)
治疗流程
急性发病
合并胆总管结石、原发性硬化性胆管炎或者 HIV 相关性胆管病变。
撰稿人
作者
Douglas G. Adler, MD, FACG, AGAF, FASGE
Professor of Medicine
Division of Gastroenterology
Department of Internal Medicine
Huntsman Cancer Institute
University of Utah
Salt Lake City
UT
利益声明
DGA has consulted for BSC and Merit, who make endoscopic retrograde cholangio-pancreatography (ERCP) products. He is also an author of references cited in this topic.
鸣谢
Dr Douglas G. Adler would like to gratefully acknowledge Dr Andrew S. Fedoravicius, a previous contributor to this topic.
利益声明
ASF declares that he has no competing interests.
同行评议者
David J. Hackam, MD, PhD
Associate Professor of Pediatric Surgery
University of Pittsburgh School of Medicine
Pittsburgh
PA
利益声明
DJH declares that he has no competing interests.
Todd Baron, MD
Professor of Medicine
Division of Gastroenterology & Hepatology
Mayo Clinic Rochester
Rochester
MN
利益声明
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
利益声明
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
利益声明
BE declares that he has no competing interests.
参考文献
关键文献
Kimura Y, Takada T, Strasberg SM, et al. TG13 current terminology, etiology, and epidemiology of acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci. 2013 Jan;20(1):8-23.全文 摘要
Gigot JF, Leese T, Dereme T, et al. Acute cholangitis: multivariate analysis of risk factors. Ann Surg. 1989 Apr;209(4):435-8.全文 摘要
Qureshi WA. Approach to the patient who has suspected acute bacterial cholangitis. Gastroenterol Clin North Am. 2006 Jun;35(2):409-23. 摘要
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.全文 摘要
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.全文 摘要
Mayumi T, Okamoto K, Takada T, et al. Tokyo Guidelines 2018: management bundles for acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci. 2018 Jan;25(1):96-100.全文 摘要
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.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
- 急性胆囊炎
- 消化性溃疡疾病
- 急性胰腺炎
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