www.xxx.国产,wwww777,欧美aaaaaa级爽激情会所,性xxxxbbbb免费播放视频

《2009EASL臨床實(shí)踐指南：膽汁淤積性肝病的治療》內(nèi)容預(yù)覽

Careful patient history and physical examination are essential in the diagnostic process and may provide valu-able information so that an experienced clinician can pre-dict the nature of cholestasis in many cases . Presence of extrahepatic diseases has to be recorded. A thorough occupational and drug history is imperative and any med-ications taken within 6 weeks of presentation may be incriminated (and discontinued); this includes herbal medicines, vitamins and other substances. A history of fever, especially when accompanied by rigors or right upper quadrant abdominal pain is suggestive of cholangi-tis due to obstructive diseases (particularly choledocholi-thiasis), but may be seen in alcoholic disease and rarely, viral hepatitis. A history of prior biliary surgery also increases the likelihood that biliary obstruction is present. Finally, a family history of cholestatic liver disease sug-gests a possibility of a hereditary disorder. Some chole-static disorders are observed only under certain circumstances (e.g., pregnancy, childhood, liver trans-plantation, HIV-infection), and may require specific investigations that are not relevant in other populations.

Abdominal ultrasonography is usually the first step to exclude dilated intra- and extrahepatic ducts and mass lesions because it is rather sensitive and specific, non-invasive, portable and relatively inexpensive. Its disadvantages are that its findings are operator-depen-dent and abnormalities of bile ducts such as those observed in sclerosing cholangitis may be missed. Fur-thermore, the lower common bile duct and pancreas are usually not well depicted. Computed tomography of the abdomen is less interpreter-dependent, but is asso-ciated with radiation exposure and may be not as good as ultrasound at delineating the biliary tree.

If bile duct abnormalities are present, further work-up depends on the presumed cause. From a purely diagnostic perspective, magnetic resonance cholangiopancreatogra-phy (MRCP) is a safe option to explore the biliary tree. Its accuracy for detecting biliary tract obstruction approa-ches that of endoscopic retrograde cholangiopancreatog-raphy (ERCP) when performed in experienced centres with state-of-the-art technology. Endoscopic ultrasound (EUS) is equivalent to MRCP in the detection of bile duct stones and lesions causing extrahepatic obstruction and may be preferred to MRCP in endoscopic units.

點(diǎn)擊下載完整版：《2009EASL臨床實(shí)踐指南：膽汁淤積性肝病的治療》