小结
定义
病史和体格检查
关键诊断因素
- 右上腹或者上腹部疼痛（通常持续 >30 分钟）
- 存在的危险因素
其他诊断因素
- 餐后痛
- 右上象限或上腹部压痛
- 恶心
- 黄疸
危险因素
- 年龄增长
- 女性
- 肥胖、糖尿病和代谢综合征
- 胆石症家族史
- 基因突变
- 妊娠/外源性雌激素
- 非酒精性脂肪肝病
- 长时间的饥饿或者体重短期内快速下降
- 全胃肠外营养 (TPN)
- 药物治疗
- 回肠末端疾病或者切除
- 血红蛋白病
- 拉丁美洲和美国土著人
- 饮食及生活方式
- 胆囊幽门螺杆菌感染
诊断性检查
首要检查
- 腹部超声
- 血清肝功能检查
- 全血细胞计数 (FBC）
- 血清脂肪酶或者淀粉酶
需考虑的检查
- 磁共振胰胆管造影术 (MRCP)
- 超声内镜扫描（EUS）
- 腹部 CT 扫描
治疗流程
有症状的胆石症
有或无症状的胆总管结石
无症状的胆石症
撰稿人
专家顾问
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.
Acknowledgements
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
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.
Luke Evans, MBBS, FRCS (GenSurg) MCh, DGM, FEBS (Emerg Surg)
Consultant in Emergency General Surgery
Service Director for Emergency Assessment Unit (Surgical)
Norfolk and Norwich University Hospitals
Norwich
UK
利益声明
LE declares that he has no competing interests.
编辑
Celia Pincus
Section Editor, BMJ Best Practice
利益声明
CP declares that she has no competing interests.
Jo Haynes
Head of Editorial, BMJ Knowledge Centre
利益声明
JH 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.
Julie Costello
Comorbidities Editor, BMJ Best Practice
利益声明
JC declares that she has no competing interests.
鉴别诊断
- 消化性溃疡 (PUD)
- 胆囊癌
- 胆囊息肉
更多 鉴别诊断指南
- 关于胆结石预防、诊断和治疗的 EASL 临床实践指南
- 胆石病：诊断和管理
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