ヒグチ　リヨウタ   Higuchi Riyouta   樋口　亮太    所属   医学部 医学科（附属八千代医療センター）    職種   講師
論文種別	原著
言語種別	英語
査読の有無	査読なし
表題	Tokyo Guidelines 2018: initial management of acute biliary infection and flowchart for acute cholangitis.
掲載誌名	正式名：Journal of hepato-biliary-pancreatic sciences 略　 称：J Hepatobiliary Pancreat Sci ISSNコード：(1868-6982)1868-6974(Linking)
掲載区分	国内
巻・号・頁	25(1),pp.31-40
著者・共著者	MIURA Fumihiko,OKAMOTO Kohji,TAKADA Tadahiro,Strasberg Steven M,Asbun Horacio J,Pitt Henry A,GOMI Harumi,Solomkin Joseph S,Schlossberg David,Han Ho-Seong,Kim Myung-Hwan,Hwang Tsann-Long,Chen Miin-Fu,Huang Wayne Shih-Wei,KIRIYAMA Seiki,ITOI Takao,Garden O James,Liau Kui-Hin,HORIGUCHI Akihiko,Liu Keng-Hao,Su Cheng-Hsi,Gouma Dirk J,Belli Giulio,Dervenis Christos,Jagannath Palepu,Chan Angus C W,Lau Wan Yee,ENDO Itaru,SUZUKI Kenji,Yoon Yoo-Seok,de Santibañes Eduardo,Giménez Mariano Eduardo,Jonas Eduard,Singh Harjit,HONDA Goro,ASAI Koji,MORI Yasuhisa,WADA Keita,HIGUCHI Ryota,WATANABE Manabu,RIKIYAMA Toshiki,SATA Naohiro,KANO Nobuyasu,UMEZAWA Akiko,MUKAI Shuntaro,TOKUMURA Hiromi,HATA Jiro,KOZAKA Kazuto, IWASHITA Yukio,HIBI Taizo,YOKOE Masamichi,KIMURA Taizo,KITANO Seigo,INOMATA Masafumi,HIRATA Koichi,SUMIYAMA Yoshinobu,IMUI Kazuo,YAMAMOTO Masakazu
発行年月	2018/01
概要	The initial management of patients with suspected acute biliary infection starts with the measurement of vital signs to assess whether or not the situation is urgent. If the case is judged to be urgent, initial medical treatment should be started immediately including respiratory/circulatory management if required, without waiting for a definitive diagnosis. The patient's medical history is then taken; an abdominal examination is performed; blood tests, urinalysis, and diagnostic imaging are carried out; and a diagnosis is made using the diagnostic criteria for cholangitis/cholecystitis. Once the diagnosis has been confirmed, initial medical treatment should be started immediately, severity should be assessed according to the severity grading criteria for acute cholangitis/cholecystitis, and the patient's general status should be evaluated. For mild acute cholangitis, in most cases initial treatment including antibiotics is sufficient, and most patients do not require biliary drainage. However, biliary drainage should be considered if a patient does not respond to initial treatment. For moderate acute cholangitis, early endoscopic or percutaneous transhepatic biliary drainage is indicated. If the underlying etiology requires treatment, this should be provided after the patient's general condition has improved; endoscopic sphincterotomy and subsequent choledocholithotomy may be performed together with biliary drainage. For severe acute cholangitis, appropriate respiratory/circulatory management is required. Biliary drainage should be performed as soon as possible after the patient's general condition has been improved by initial treatment and respiratory/circulatory management. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.
DOI	10.1002/jhbp.509
PMID	28941329