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Diagnostic Criteria for Cholangitis Print E-mail
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Written by G. Firman MD   
Wednesday, 27 May 2009 19:00
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Diagnostic criteria of acute cholangitis: Tokyo Guidelines

 

A. Clinical context and clinical manifestations

1. History of biliary disease
2. Fever and/or chills
3. Jaundice
4. Abdominal pain (right upper quadrant or upper abdominal)

B. Laboratory data

5. Evidence of inflammatory responsea
6. Abnormal liver function testsb

C. Imaging findings

7. Biliary dilatation, or evidence of an etiology (stricture, stone, stent etc)


Suspected diagnosis Two or more items in A


Definite diagnosis

(1) Charcot’s triad (2 + 3 + 4)
(2) Two or more items in A + both items in B and item C


a Abnormal WBC count, increase of serum C-reactive protein (CRP) level, and other changes indicating inflammation
b Increased serum ALP, r-GTP (GGT), AST, and ALT levels

 

 

Criteria for severity assessment of acute cholangitis: Tokyo Guidelines

 Severity of acute cholangitis
 Criterion
 Mild (grade I) Moderate (grade II) Severe (grade III)
 Onset of organ dysfunction No No Yes
 Response to initial medical treatmenta Yes No No
 
a Consisting of general supportive care and antibiotics
 
 
 
Definitions of severity assessment criteria for acute cholangitis
 
Mild (grade I) acute cholangitis
“Mild (grade I)” acute cholangitis is defined as acute cholangitis which responds to the initial medical treatmenta
 
Moderate (grade II) acute cholangitis
“Moderate (grade II)” acute cholangitis is defined as acute cholangitis that does not respond to the initial medical treatmenta and is not accompanied by organ dysfunction
 
Severe (grade III) acute cholangitis
“Severe (grade III)” acute cholangitis is defined as acute cholangitis that is associated with the onset of dysfunction at least in any one of the following organs/systems:
1. Cardiovascular system: Hypotension requiring dopamine >/= 5 ug/kg per min, or any dose of dobutamine
2. Nervous system: Disturbance of consciousness
3. Respiratory system: PaO2/FiO2 ratio < 300
4. Kidney: Serum creatinine > 2.0 mg/dl
5. Liver: PT-INR > 1.5
6. Hematological system: Platelet count < 100 000 /ul
 
Note: compromised patients, e.g., elderly (>75 years old) and patients with medical comorbidities, should be monitored closely
a General supportive care and antibiotics
 
 
 
References:

  1. Lee CC, Chang IJ, Lai YC, Chen SY, Chen SC. Epidemiology and prognostic determinants of patients with bacteremic cholecystitis or cholangitis. Am. J. Gastroenterol. 2007 Mar;102(3):563-9. [Medline]

  2. Wada K, Takada T, Kawarada Y, Nimura Y, Miura F, Yoshida M, Mayumi T, Strasberg S, Pitt HA, Gadacz TR, Büchler MW, Belghiti J, de Santibanes E, Gouma DJ, Neuhaus H, Dervenis C, Fan ST, Chen MF, Ker CG, Bornman PC, Hilvano SC, Kim SW, Liau KH, Kim MH. Diagnostic criteria and severity assessment of acute cholangitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg. 2007;14(1):52-8. [Medline]
 
 
Created: Jul 16, 2007 
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Last Updated on Saturday, 28 January 2012 14:10
 

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