{"id":38,"date":"2009-05-28T03:00:00","date_gmt":"2009-05-28T03:00:00","guid":{"rendered":"https:\/\/medicalcriteria.com\/web\/gascholangitis\/"},"modified":"2025-05-14T19:09:25","modified_gmt":"2025-05-14T19:09:25","slug":"gascholangitis","status":"publish","type":"post","link":"https:\/\/medicalcriteria.com\/web\/gascholangitis\/","title":{"rendered":"Diagnostic Criteria for Cholangitis"},"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 cholangitis, also referred to as ascending cholangitis, is an infection of the biliary tree characterized by fever, jaundice, and abdominal pain, which in most cases is the consequence of biliary obstruction. Diagnosis is commonly made by the presence of clinical features, laboratory tests, and imaging studies.<!--more--><\/p>\n<div class=\"Section1\"><strong>Diagnostic criteria of acute cholangitis: Tokyo Guidelines<\/strong><\/div>\n<p class=\"MsoNormal\">A. Clinical context and clinical manifestations<\/p>\n<p style=\"padding-left: 40px;\">1. History of biliary disease<br \/>\n2. Fever and\/or chills<br \/>\n3. Jaundice<br \/>\n4. Abdominal pain (right upper quadrant or upper abdominal)<\/p>\n<p class=\"MsoNormal\">B. Laboratory data<\/p>\n<p style=\"padding-left: 40px;\">5. Evidence of inflammatory response<sup>a<\/sup><br \/>\n6. Abnormal liver function tests<sup>b<\/sup><\/p>\n<p class=\"MsoNormal\">C. Imaging findings<\/p>\n<p class=\"MsoNormal\" style=\"padding-left: 40px;\">7. Biliary dilatation, or evidence of an etiology (stricture, stone, stent etc)<\/p>\n<p class=\"MsoNormal\"><strong>Suspected diagnosis<\/strong> Two or more items in A<\/p>\n<p><strong>Definite diagnosis <\/strong><\/p>\n<p class=\"MsoNormal\">(1) Charcot\u2019s triad (2 + 3 + 4)<br \/>\n(2) Two or more items in A + both items in B and item C<\/p>\n<p class=\"MsoNormal\"><sup>a<\/sup> Abnormal WBC count, increase of serum C-reactive protein (CRP) level, and other changes indicating inflammation<br \/>\n<sup>b<\/sup> Increased serum ALP, r-GTP (GGT), AST, and ALT levels<\/p>\n<p class=\"MsoNormal\"><strong>Criteria for severity assessment of acute cholangitis: Tokyo Guidelines <\/strong><\/p>\n<table style=\"border-collapse: collapse; width: 100%;\" border=\"1\">\n<tbody>\n<tr>\n<td><\/td>\n<td colspan=\"3\" align=\"center\">Severity of acute cholangitis<\/td>\n<\/tr>\n<tr>\n<td>Criterion<\/td>\n<td align=\"center\">Mild (grade I)<\/td>\n<td align=\"center\">Moderate (grade II)<\/td>\n<td align=\"center\">Severe (grade III)<\/td>\n<\/tr>\n<tr>\n<td>Onset of organ dysfunction<\/td>\n<td align=\"center\">No<\/td>\n<td align=\"center\">No<\/td>\n<td align=\"center\">Yes<\/td>\n<\/tr>\n<tr>\n<td>Response to initial medical treatment<sup>a<\/sup><\/td>\n<td align=\"center\">Yes<\/td>\n<td align=\"center\">No<\/td>\n<td align=\"center\">No<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<div class=\"Section1\"><sup>a<\/sup> Consisting of general supportive care and antibiotics<\/div>\n<div class=\"Section1\">\n<p>&nbsp;<\/p>\n<p><strong>Definitions of severity assessment criteria for acute cholangitis<\/strong><\/p>\n<div class=\"Section1\">\n<p><strong>Mild (grade I) acute cholangitis<\/strong><br \/>\n&#8220;Mild (grade I)&#8221; is defined as acute cholangitis that is responsive to initial medical treatment.<\/p>\n<p><strong>Moderate (grade II) acute cholangitis<\/strong><br \/>\n\u201cModerate (grade II)\u201d acute cholangitis is defined as acute cholangitis that does not respond to the initial medical treatment<sup>a<\/sup> and is not accompanied by organ dysfunction<\/p>\n<p><strong>Severe (grade III) acute cholangitis<\/strong><br \/>\n\u201cSevere (grade III)\u201d 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:<\/p>\n<ol>\n<li>Cardiovascular system: Hypotension requiring dopamine &gt;\/= 5 ug\/kg per min, or any dose of dobutamine<\/li>\n<li>Nervous system: Disturbance of consciousness<\/li>\n<li>Respiratory system: PaO2\/FiO2 ratio &lt; 300<\/li>\n<li>Kidney: Serum creatinine &gt; 2.0 mg\/dl<\/li>\n<li>Liver: PT-INR &gt; 1.5<\/li>\n<li>Hematological system: Platelet count &lt; 100 000 \/ul<\/li>\n<\/ol>\n<p>Note: compromised patients, e.g., elderly (&gt;75 years old) and patients with medical comorbidities, should be monitored closely<br \/>\n<sup>a<\/sup> General supportive care and antibiotics<\/p>\n<p><strong>References:<\/strong><\/p>\n<\/div>\n<div class=\"Section1\">\n<div class=\"Section1\">\n<div class=\"Section1\">\n<ol>\n<li class=\"MsoNormal\">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. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/17335448\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<li>Wada K, Takada T, Kawarada Y, Nimura Y, Miura F, Yoshida M, Mayumi T, Strasberg S, Pitt HA, Gadacz TR, B\u00fcchler 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. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/17252297\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<\/ol>\n<\/div>\n<div><\/div>\n<div class=\"Section1\">Created: Jul 16, 2007<\/div>\n<\/div>\n<\/div>\n<\/div>\n<p><\/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":"closed","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":[53],"tags":[376,375,16,15,14,13,1413],"class_list":["post-38","post","type-post","status-publish","format-standard","hentry","category-gastroenterology","tag-cholangitis","tag-colangitis","tag-criteria","tag-criterios","tag-diagnostic","tag-diagnostico","tag-gastroenterology"],"modified_by":"Guillermo Firman","_links":{"self":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/38","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=38"}],"version-history":[{"count":8,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/38\/revisions"}],"predecessor-version":[{"id":10030,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/38\/revisions\/10030"}],"wp:attachment":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/media?parent=38"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/categories?post=38"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/tags?post=38"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}