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
- 陶土样大便
- 瘙痒
- 低血压
- 精神状态改变
危险因素
- 年龄＞50 岁
- 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
- 免疫检查点抑制剂
- IgG4 相关疾病
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
- 血培养
- 凝血检查组合
- 经腹超声
需考虑的检查
- 使用静脉造影剂的腹部增强 CT
- 内镜逆行胰胆管造影术 (ERCP)
- 磁共振胰胆管造影术 (MRCP)
- 经皮经肝穿刺胆道造影 (PTC)
- 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
专家顾问
Christian Macutkiewicz, MD, FHEA, FRCS
Consultant General & Hepato-Pancreato-Biliary (HPB) Surgeon
Manchester Royal Infirmary
Manchester
UK
利益声明
CM declares that he has no competing interests.
鸣谢
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.
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.
编辑
Julie Costello
Comorbidities Editor, BMJ Best Practice
利益声明
JC declares that she has no competing interests.
Anna Ellis
Head of Editorial, BMJ Best Practice
利益声明
AE 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.
鉴别诊断
- 急性胆囊炎
- 消化性溃疡病
- 急性胰腺炎
更多 鉴别诊断指南
- ACG 临床指南：胆管狭窄的诊断和管理
- ASGE 关于胆管炎的管理指南
更多 指南Videos
静脉穿刺和抽血的动画演示
外周静脉置管的动画演示
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