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Diagnostic criteria and severity assessment of acute cholangitis: Tokyo Guidelines

Cited 134 time in Web of Science Cited 148 time in Scopus
Authors
Wada, Keita; Takada, Tadahiro; Kawarada, Yoshifumi; Nimura, Yuji; Miura, Fumihiko; Yoshida, Masahiro; Mayumi, Toshihiko; Strasberg, Steven; Pitt, Henry A; Gadacz, Thomas R; Buchler, Markus W; Belghiti, Jacques; de Santibanes, Eduardo; Gouma, Dirk J; Neuhaus, Horst; Dervenis, Christos; Fan, Sheung-Tat; Chen, Miin-Fu; Ker, Chen-Guo; Bornman, Philippus C; Hilvano, Serafin C; Kim, Sun-Whe; Liau, Kui-Hin; Kim, Myung-Hwan
Issue Date
2007-01-26
Publisher
Springer Verlag
Citation
J Hepatobiliary Pancreat Surg. 2007;14(1):52-8. Epub 2007 Jan 30
Keywords
Acute DiseaseCholangitis/blood/classification/*diagnosisHumansPrognosisSeverity of Illness Index
Abstract
Because acute cholangitis sometimes rapidly progresses to a severe form accompanied by organ dysfunction, caused by the systemic inflammatory response syndrome (SIRS) and/or sepsis, prompt diagnosis and severity assessment are necessary for appropriate management, including intensive care with organ support and urgent biliary drainage in addition to medical treatment. However, because there have been no standard criteria for the diagnosis and severity assessment of acute cholangitis, practical clinical guidelines have never been established. The aim of this part of the Tokyo Guidelines is to propose new criteria for the diagnosis and severity assessment of acute cholangitis based on a systematic review of the literature and the consensus of experts reached at the International Consensus Meeting held in Tokyo 2006. Acute cholangitis can be diagnosed if the clinical manifestations of Charcot's triad, i.e., fever and/or chills, abdominal pain (right upper quadrant or epigastric), and jaundice are present. When not all of the components of the triad are present, then a definite diagnosis can be made if laboratory data and imaging findings supporting the evidence of inflammation and biliary obstruction are obtained. The severity of acute cholangitis can be classified into three grades, mild (grade I), moderate (grade II), and severe (grade III), on the basis of two clinical factors, the onset of organ dysfunction and the response to the initial medical treatment. "Severe (grade III)" acute cholangitis is defined as acute cholangitis accompanied by at least one new-onset organ dysfunction. "Moderate (grade II)" acute cholangitis is defined as acute cholangitis that is unaccompanied by organ dysfunction, but that does not respond to the initial medical treatment, with the clinical manifestations and/or laboratory data not improved. "Mild (grade I)" acute cholangitis is defined as acute cholangitis that responds to the initial medical treatment, with the clinical findings improved.
ISSN
0944-1166 (Print)
Language
English
URI
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=17252297

http://hdl.handle.net/10371/15847
DOI
https://doi.org/10.1007/s00534-006-1156-7
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College of Medicine/School of Medicine (의과대학/대학원)Surgery (외과학전공)Journal Papers (저널논문_외과학전공)
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