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 |
“Mild (grade I)” acute cholangitis is defined as acute cholangitis which responds to the initial medical treatmenta
“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 is defined as acute cholangitis that is associated with the onset of dysfunction at least in any one of the following organs/systems:
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
a General supportive care and antibiotics
- 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]
- 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]