Diagnostic criteria and severity assessment of acute cholangitis: Tokyo Guidelines View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2007-01-30

AUTHORS

Keita Wada, Tadahiro Takada, Yoshifumi Kawarada, Yuji Nimura, Fumihiko Miura, Masahiro Yoshida, Toshihiko Mayumi, Steven Strasberg, Henry A. Pitt, Thomas R. Gadacz, Markus W. Büchler, Jacques Belghiti, Eduardo de Santibanes, Dirk J. Gouma, Horst Neuhaus, Christos Dervenis, Sheung-Tat Fan, Miin-Fu Chen, Chen-Guo Ker, Philippus C. Bornman, Serafin C. Hilvano, Sun-Whe Kim, Kui-Hin Liau, Myung-Hwan Kim

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. More... »

PAGES

52-58

References to SciGraph publications

Journal

Author Affiliations

  • Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605 Japan
  • Mie University School of Medicine, Mie, Japan
  • Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
  • Department of Emergency Medicine and Intensive Care, Nagoya University School of Medicine, Nagoya, Japan
  • Department of Surgery, Washington University in St Louis and Barnes-Jewish Hospital, St Louis, USA
  • Department of Surgery, Indiana University School of Medicine, Indianapolis, USA
  • Department of Gastrointestinal Surgery, Medical College of Georgia, Georgia, USA
  • Department of Surgery, University of Heidelberg, Heidelberg, Germany
  • Department of Digestive Surgery and Transplantation, Hospital Beaujon, Clichy, France
  • Department of Surgery, University of Buenos Aires, Buenos Aires, Argentina
  • Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
  • Department of Internal Medicine, Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany
  • First Department of Surgery, Agia Olga Hospital, Athens, Greece
  • Department of Surgery, The University of Hong Kong, Hong Kong, China
  • Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
  • Division of HPB Surgery, Yuan’s General Hospital, Taoyuan, Taiwan
  • Division of General Surgery, University of Cape Town, Cape Town, South Africa
  • Department of Surgery, Philippine General Hospital, University of the Philippines, Manila, Philippines
  • Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
  • Department of Surgery, Tan Tock Seng Hospital/Hepatobiliary Surgery, Medical Centre, Singapore, Singapore
  • Department of Internal Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1007/s00534-006-1156-7

    DOI

    http://dx.doi.org/10.1007/s00534-006-1156-7

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1016511017

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/17252297


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