{"id":2340,"date":"2015-07-24T15:33:50","date_gmt":"2015-07-24T15:33:50","guid":{"rendered":"https:\/\/medicalcriteria.com\/web\/surcol\/"},"modified":"2026-03-20T19:02:27","modified_gmt":"2026-03-20T19:02:27","slug":"surcol","status":"publish","type":"post","link":"https:\/\/medicalcriteria.com\/web\/surcol\/","title":{"rendered":"Diagnosis and Determination of Severity of Acute Cholecystitis"},"content":{"rendered":"<div class=\"99c380e4b4a7b96c35d7ddf7dcb434e8\" data-index=\"1\" style=\"float: none; margin:0px 0 0px 0; text-align:center;\">\n<script async src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js\"><\/script>\r\n<!-- MC 2019- Horizontal -->\r\n<ins class=\"adsbygoogle\"\r\n     style=\"display:block\"\r\n     data-ad-client=\"ca-pub-0127150553352455\"\r\n     data-ad-slot=\"3806776041\"\r\n     data-ad-format=\"auto\"\r\n     data-full-width-responsive=\"true\"><\/ins>\r\n<script>\r\n     (adsbygoogle = window.adsbygoogle || []).push({});\r\n<\/script>\n<\/div>\n<p>Acute cholecystitis is a very common complication of cholelithiasis, and as such is frequently encountered in surgical practice. TG07 diagnostic criteria are recognized as those to be recommended in current care for acute cholecystitis.<br \/>\n<!--more--><br \/>\n<b>Guidelines for the Diagnosis and Determination of Severity of Acute Cholecystitis<\/b><br \/>\n<b><\/b><\/p>\n<p><b>Diagnostic Criteria<\/b><br \/>\nLocal signs of inflammation<\/p>\n<ul>\n<li>Murphy\u2019s sign<\/li>\n<li>Mass, pain, or tenderness in right upper quadrant<\/li>\n<\/ul>\n<p>Systemic signs of inflammation<\/p>\n<ul>\n<li>Fever<\/li>\n<li>Elevated levels of C-reactive protein<\/li>\n<li>Leukocytosis<\/li>\n<\/ul>\n<p>Findings on imaging characteristic of acute cholecystitis<\/p>\n<ul>\n<li>Gallbladder-wall thickness &gt;\/=5 mm, pericholecystic fluid, or direct tenderness when probe is pushed against gallbladder\u00a0(i.e., ultrasonographic Murphy\u2019s sign)<\/li>\n<\/ul>\n<p><b>Diagnosis<\/b><br \/>\nSuspected<\/p>\n<ul>\n<li>Positivity for one item in local signs of inflammation and one item in systemic signs of inflammation<\/li>\n<\/ul>\n<p>Definitive<\/p>\n<ul>\n<li>Positivity for one item in local signs of inflammation, one item in systemic signs of inflammation, and findings\u00a0on imaging characteristic of acute cholecystitis<\/li>\n<\/ul>\n<p><b>Disease severity<\/b><br \/>\nGrade I (mild)<\/p>\n<ul>\n<li>Acute cholecystitis in otherwise healthy patient with mild local inflammatory changes and without organ dysfunction<\/li>\n<li>Criteria for grade II or III not met<\/li>\n<\/ul>\n<p>Grade II (moderate): any one of the following characteristics<\/p>\n<ul>\n<li>Leukocytosis (&gt;18,000 cells per mm3)<\/li>\n<li>Palpable, tender mass in right upper quadrant<\/li>\n<li>Symptom duration &gt;72 hr<\/li>\n<li>Marked local inflammation (gangrenous or emphysematous cholecystitis, pericholecystic or hepatic abscess,\u00a0biliary peritonitis<\/li>\n<\/ul>\n<p>Grade III (severe): organ dysfunction in any one of the following systems<\/p>\n<ul>\n<li>Cardiovascular:\u00a0Hypotension requiring administration of &gt;\/= 5 ug\/kg\/min of dopamine or any dose of norepinephrine<\/li>\n<li>Neurologic:\u00a0Decreased level of consciousness<\/li>\n<li>Respiratory:\u00a0Pao<sub>2<\/sub>:Fio<sub>2<\/sub> &lt;300<\/li>\n<li>Renal:\u00a0Oliguria, and\/or\u00a0Creatinine &gt;2.0 mg\/dl (&gt;177 umol\/liter)<\/li>\n<li>Hepatic:\u00a0International normalized ratio (INR) &gt;1.5<\/li>\n<li>Hematologic:\u00a0Platelet count &lt;100,000\/mm<sup>3<\/sup><\/li>\n<\/ul>\n<p>* Pao<sub>2<\/sub> denotes partial pressure of arterial oxygen, and Fio2 the fraction of inspired oxygen.<\/p>\n<p>&nbsp;<\/p>\n<p><b>References:<\/b><\/p>\n<ol>\n<li>Yokoe M, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Gomi H, Pitt HA, Gouma DJ, Garden OJ, B\u00fcchler MW, Kiriyama S, Kimura Y, Tsuyuguchi T, Itoi T, Yoshida M, Miura F, Yamashita Y, Okamoto K, Gabata T, Hata J, Higuchi R, Windsor JA, Bornman PC, Fan ST, Singh H, de Santibanes E, Kusachi S, Murata A, Chen XP, Jagannath P, Lee S, Padbury R, Chen MF; Tokyo Guidelines Revision Committee.\u00a0New diagnostic criteria and severity assessment of acute cholecystitis in revised Tokyo Guidelines. J Hepatobiliary Pancreat Sci. 2012 Sep;19(5):578-85.\u00a0<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/22872303\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<li>Baron TH, Grimm IS, Swanstrom LL. Interventional Approaches to Gallbladder Disease.\u00a0N Engl J Med. 2015 Jul 23;373(4):357-65.\u00a0<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/26200981\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<li>Kobayashi Y, Oikawa R, Shibuya Y, Tatsuno M, Kamiyama A, Ozawa T, Hara K, Hatano S, Hata S, Yamaguchi H. Validation of the Safe Application of Tokyo Guideline 2018 (TG18) Severity Grading and Treatment Algorithm in Super-Elderly Patients Aged 85 and Over With Acute Cholecystitis: A Study in the Japanese Tertiary Care Hospital. Ann Gastroenterol Surg. 2025 Oct 7;10(2):570-577. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/41799575\/\" target=\"_blank\" rel=\"noopener\">[Medline]<\/a><\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n<p>Created Jul 24, 2015.<br \/>\nUp-date Mar 20, 2026.<\/p>\n\n<div style=\"font-size: 0px; height: 0px; line-height: 0px; margin: 0; padding: 0; clear: both;\"><\/div>","protected":false},"excerpt":{"rendered":"<p>Sorry, this entry is only available in Espa\u00f1ol.<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"no","_lmt_disable":"no","_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[165],"tags":[231,230,229,228,782,781,123,13,273,274,226,180,783],"class_list":["post-2340","post","type-post","status-publish","format-standard","hentry","category-surgery","tag-acute","tag-aguda","tag-cholecystitis","tag-colecistitis","tag-determinacion","tag-determination","tag-diagnosis","tag-diagnostico","tag-guia","tag-guidelines","tag-severidad","tag-severity","tag-tg07"],"modified_by":"Guillermo Firman","_links":{"self":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2340","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/comments?post=2340"}],"version-history":[{"count":4,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2340\/revisions"}],"predecessor-version":[{"id":10721,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2340\/revisions\/10721"}],"wp:attachment":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/media?parent=2340"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/categories?post=2340"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/tags?post=2340"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}