Diagnostic criteria and severity assessment of acute cholecystitis: Tokyo Guidelines

Abstract

The aim of this article is to propose new criteria for the diagnosis and severity assessment of acute cholecystitis, based on a systematic review of the literature and a consensus of experts. A working group reviewed articles with regard to the diagnosis and treatment of acute cholecystitis and extracted the best current available evidence. In addition to the evidence and face-to-face discussions, domestic consensus meetings were held by the experts in order to assess the results. A provisional outcome statement regarding the diagnostic criteria and criteria for severity assessment was discussed and finalized during an International Consensus Meeting held in Tokyo 2006. Patients exhibiting one of the local signs of inflammation, such as Murphy’s sign, or a mass, pain or tenderness in the right upper quadrant, as well as one of the systemic signs of inflammation, such as fever, elevated white blood cell count, and elevated C-reactive protein level, are diagnosed as having acute cholecystitis. Patients in whom suspected clinical findings are confirmed by diagnostic imaging are also diagnosed with acute cholecystitis. The severity of acute cholecystitis is classified into three grades, mild (grade I), moderate (grade II), and severe (grade III). Grade I (mild acute cholecystitis) is defined as acute cholecystitis in a patient with no organ dysfunction and limited disease in the gallbladder, making cholecystectomy a low-risk procedure. Grade II (moderate acute cholecystitis) is associated with no organ dysfunction but there is extensive disease in the gallbladder, resulting in difficulty in safely performing a cholecystectomy. Grade II disease is usually characterized by an elevated white blood cell count; a palpable, tender mass in the right upper abdominal quadrant; disease duration of more than 72 h; and imaging studies indicating significant inflammatory changes in the gallbladder. Grade III (severe acute cholecystitis) is defined as acute cholecystitis with organ dysfunction.

Akut Viral Hepatit A Seyri Esnasında Görülen Akut Taşsız Kolesistit

“…Buna karşın vakaların %15'inde hematolojik komplikasyonlar hemoliz, anemi, lökositoz, nötropeni, trombositopeni, immün trombositopenik purpura, trombositoz, asit, plevral efüzyon, fulminan hepatit, masif hepatik nekroz, uzamış kolestaz, akut taşsız kolesistit ve akut renal yetersizlik gibi komplikasyonlar bildirilmiştir (5)(6)(7)(8).…”

“…Sağ üst kadran ağrısı, ateş, sarılık, lökositoz ve karaciğer fonksiyon testi anormallikleri gibi spesifik olmayan bulguları olduğu için klinik tanı koymak zordur (3). Akut kolesistitin USG tanı kriterleri; sonografik Murphy işareti, safra kesesi duvar kalınlığının artışı (>4 mm), safra kesesinin genişlemesi, safra taşı, debris ekosu görünümünün olmaması, intra ve ekstra hepatik safra yollarında genişleme olmaması, safra kesesi etrafında sıvı birikimi, safra kesesi duvarında lineer ve strial hipoekojen görünümdür (6,8,11). Hipoalbüminemi, asit yokluğunda safra kesesi etrafında sıvı birikimi, seroza altında ödem ve intramural gaz birikimi bildirilmektedir (3,8).…”

Laparoscopic approach to acute abdomen from the Consensus Development Conference of the Società Italiana di Chirurgia Endoscopica e nuove tecnologie (SICE), Associazione Chirurghi Ospedalieri Italiani (ACOI), Società Italiana di Chirurgia (SIC), Società Italiana di Chirurgia d’Urgenza e del Trauma (SICUT), Società Italiana di Chirurgia nell’Ospedalità Privata (SICOP), and the European Association for Endoscopic Surgery (EAES)

“…Very similar sets of criteria with almost 100 % specificity have been suggested in the EAES guidelines of 2006 [2] and in the Tokyo Consensus Meeting Guidelines [6]: both can be used in clinical practice.…”

Acute Biliary tract infections, Diagnostic criteria and Treatment

“…Grade 11 disease is usually characterized by an elevated white cell count; disease duration of more than 72h; and imaging studies indicating significant inflammatory changes in the gallbladder. Grade 111(severe acute choelocystitis) is defined as acute choleocystitis with organ dysfunction [6].Acute cholangitis results in presentation with the clinical findings mentioned above. Abnormalities suggestive of sepsis syndrome, including leukocytosis, are frequently observed.…”

“…Latina women showed a higher prevalence than whites, blacks or Asians. Black women did not have a significantly higher prevalence than the white sample, other factors that appear related to the incidence of gallstones include,obesity,parity,using estrogens and diabetes mellitus [4].Mustafa I,et al reported 12 cases of acute acalculous choleocystitis(AAC) in children [5].The severity of acute choleocystitis is classified into three grades mild(grade I),moderate (grade II),and severe(gradeIII),Grade III(severe acute choleocystitis) is defined as acute cholecystitis with organ failure [6].Enteric organisms are the frequent cause of acute choleocystitis and acute cholangitis, with monomicrobial(76%) and polymicobial(24%),with anaerobes included [7].Diagnostics tests include plain roentgenograms,ultrasonography,sonographic deigns,CTscan,MRIscholangiography(endoscopic retrograde cholangiopancreatography-ERCP),HIDA(hepato-iminodiacetic acid) a functional scan test, whereas ultrasonography is an anatomic test [8,9].Empiric antibiotic regimens are aimed primarily at gram-negative bacteria.Cefazolin,ceftriaxone, and pipercillin/tazobactam are equally effective. In elderly or critically ill patient and the patient with prior common duct or complex biliary procedures, a therapeutic regimen that includes anaerobic activity is reasonable [7].Cholecystectomy remains the treatment of choice for acute choleocystitis [8].The paper reviews the diagnostic criteria, and management of acute biliary infections.…”