Cholangitis classification: Difference between revisions
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==Overview== | ==Overview== | ||
Acute cholangitis | Acute cholangitis may be classified into grade I, II, or III, depending on the severity of the condition. | ||
==Classification== | ==Classification== | ||
The severity of cholangitis can be classified into three grades, based on the onset of organ dysfunction | The severity of cholangitis can be classified into three grades, based on the onset of organ dysfunction and the patient's response to the initial medical treatment:<ref name="pmid17252297">{{cite journal |vauthors=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 |title=Diagnostic criteria and severity assessment of acute cholangitis: Tokyo Guidelines |journal=J Hepatobiliary Pancreat Surg |volume=14 |issue=1 |pages=52–8 |year=2007 |pmid=17252297 |pmc=2784515 |doi=10.1007/s00534-006-1156-7 |url=}}</ref><ref name="pmid26468310">{{cite journal |vauthors=Zimmer V, Lammert F |title=Acute Bacterial Cholangitis |journal=Viszeralmedizin |volume=31 |issue=3 |pages=166–72 |date=June 2015 |pmid=26468310 |pmc=4569195 |doi=10.1159/000430965 |url=}}</ref><ref name="pmid19652653">{{cite journal |vauthors=Lee JG |title=Diagnosis and management of acute cholangitis |journal=Nat Rev Gastroenterol Hepatol |volume=6 |issue=9 |pages=533–41 |date=September 2009 |pmid=19652653 |doi=10.1038/nrgastro.2009.126 |url=}}</ref> | ||
*Mild (grade I) | *Mild (grade I) | ||
*Moderate (grade II) | *Moderate (grade II) | ||
| Line 13: | Line 13: | ||
The severity assessment criteria for acute cholangitis according to Tokyo guidelines is as follows:<ref name="Mayumi-2013">{{Cite journal | last1 = Mayumi | first1 = T. | last2 = Someya | first2 = K. | last3 = Ootubo | first3 = H. | last4 = Takama | first4 = T. | last5 = Kido | first5 = T. | last6 = Kamezaki | first6 = F. | last7 = Yoshida | first7 = M. | last8 = Takada | first8 = T. | title = Progression of Tokyo Guidelines and Japanese Guidelines for management of acute cholangitis and cholecystitis. | journal = J UOEH | volume = 35 | issue = 4 | pages = 249-57 | year = 2013 | doi = | PMID = 24334691 }}</ref><ref name="pmid23307006">{{cite journal |vauthors=Takada T, Strasberg SM, Solomkin JS, Pitt HA, Gomi H, Yoshida M, Mayumi T, Miura F, Gouma DJ, Garden OJ, Büchler MW, Kiriyama S, Yokoe M, Kimura Y, Tsuyuguchi T, Itoi T, Gabata T, Higuchi R, Okamoto K, Hata J, Murata A, Kusachi S, Windsor JA, Supe AN, Lee S, Chen XP, Yamashita Y, Hirata K, Inui K, Sumiyama Y |title=TG13: Updated Tokyo Guidelines for the management of acute cholangitis and cholecystitis |journal=J Hepatobiliary Pancreat Sci |volume=20 |issue=1 |pages=1–7 |year=2013 |pmid=23307006 |doi=10.1007/s00534-012-0566-y |url=}}</ref><ref name="pmid29089703">{{cite journal |vauthors=Dinc T, Kayilioglu SI, Coskun F |title=Evaluation and Comparison of Charcot's Triad and Tokyo Guidelines for the Diagnosis of Acute Cholangitis |journal=Indian J Surg |volume=79 |issue=5 |pages=427–430 |year=2017 |pmid=29089703 |doi=10.1007/s12262-016-1512-z |url=}}</ref> | The severity assessment criteria for acute cholangitis according to Tokyo guidelines is as follows:<ref name="Mayumi-2013">{{Cite journal | last1 = Mayumi | first1 = T. | last2 = Someya | first2 = K. | last3 = Ootubo | first3 = H. | last4 = Takama | first4 = T. | last5 = Kido | first5 = T. | last6 = Kamezaki | first6 = F. | last7 = Yoshida | first7 = M. | last8 = Takada | first8 = T. | title = Progression of Tokyo Guidelines and Japanese Guidelines for management of acute cholangitis and cholecystitis. | journal = J UOEH | volume = 35 | issue = 4 | pages = 249-57 | year = 2013 | doi = | PMID = 24334691 }}</ref><ref name="pmid23307006">{{cite journal |vauthors=Takada T, Strasberg SM, Solomkin JS, Pitt HA, Gomi H, Yoshida M, Mayumi T, Miura F, Gouma DJ, Garden OJ, Büchler MW, Kiriyama S, Yokoe M, Kimura Y, Tsuyuguchi T, Itoi T, Gabata T, Higuchi R, Okamoto K, Hata J, Murata A, Kusachi S, Windsor JA, Supe AN, Lee S, Chen XP, Yamashita Y, Hirata K, Inui K, Sumiyama Y |title=TG13: Updated Tokyo Guidelines for the management of acute cholangitis and cholecystitis |journal=J Hepatobiliary Pancreat Sci |volume=20 |issue=1 |pages=1–7 |year=2013 |pmid=23307006 |doi=10.1007/s00534-012-0566-y |url=}}</ref><ref name="pmid29089703">{{cite journal |vauthors=Dinc T, Kayilioglu SI, Coskun F |title=Evaluation and Comparison of Charcot's Triad and Tokyo Guidelines for the Diagnosis of Acute Cholangitis |journal=Indian J Surg |volume=79 |issue=5 |pages=427–430 |year=2017 |pmid=29089703 |doi=10.1007/s12262-016-1512-z |url=}}</ref> | ||
==== | {| | ||
! colspan="4" style="background:#4479BA; color: #FFFFFF;" align="center" |Severity assessment of cholangitis | |||
|- | |||
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Criterion | |||
! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Severity | |||
|- | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Mild (grade I) | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Moderate (grade II) | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Severe (grade III) | |||
|- | |||
| style="background:#DCDCDC;" align="center" |Onset of organ dysfunction | |||
| style="background:#F5F5F5;" align="center" | – | |||
| style="background:#F5F5F5;" align="center" | – | |||
| style="background:#F5F5F5;" align="center" | + | |||
|- | |||
| style="background:#DCDCDC;" align="center" |Response to medical treatment | |||
| style="background:#F5F5F5;" align="center" | + | |||
| style="background:#F5F5F5;" align="center" | – | |||
| style="background:#F5F5F5;" align="center" | – | |||
|} | |||
====Grade I acute cholangitis==== | |||
Grade I, or mild acute cholangitis, don't meet the criteria of neither grade II (moderate) nor grade III (severe) acute cholangitis. The patient responds to initial medical treatment. | |||
====Grade II | ====Grade II acute cholangitis==== | ||
Grade II, or moderate acute cholangitis, is characterized by the presence of any two of the following: | Grade II, or moderate acute cholangitis, is characterized by the presence of any two of the following: | ||
* Abnormal WBC count: >12,000/mm<sup>3</sup>, <4,000/mm<sup>3</sup> | * Abnormal [[White blood cells|white blood cell]] ([[White blood cells|WBC]]) count: >12,000/mm<sup>3</sup>, <4,000/mm<sup>3</sup> | ||
* [[Fever]] ≥39°C | * [[Fever]] ≥39°C | ||
* Age ≥75 years | * Age ≥75 years | ||
| Line 30: | Line 45: | ||
* Decreased [[albumin]] level <0.7 x standard | * Decreased [[albumin]] level <0.7 x standard | ||
====Grade | ====Grade III acute cholangitis==== | ||
Grade | Grade III, or severe acute cholangitis, is characterized by the onset of dysfunction in at least one of the following: | ||
*[[Cardiovascular system]]: decreased [[blood pressure]] that necessitates the administration of [[dopamine]] (>5 μg/kg/min) or [[norepinephrine]] | |||
*[[Neurological|Neurological system]]: abnormal [[consciousness]] | |||
*[[Respiratory system]]: PaO2/FiO2 ratio <300 | |||
*[[Renal system]]: [[serum]] [[creatinine]] >2.0 mg/dl, decreased [[urine output]] | |||
*Hepatic system: PT-INR >1.5 | |||
*[[Hematological|Hematological system]]: [[platelet count]] < 100,000/mm<sup>3</sup> | |||
==References== | ==References== | ||
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Latest revision as of 16:52, 27 October 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amandeep Singh M.D.[2], Vendhan Ramanujam M.B.B.S [3], Farwa Haideri [4]
Overview
Acute cholangitis may be classified into grade I, II, or III, depending on the severity of the condition.
Classification
The severity of cholangitis can be classified into three grades, based on the onset of organ dysfunction and the patient's response to the initial medical treatment:[1][2][3]
- Mild (grade I)
- Moderate (grade II)
- Severe (grade III)
The severity assessment criteria for acute cholangitis according to Tokyo guidelines is as follows:[4][5][6]
| Severity assessment of cholangitis | |||
|---|---|---|---|
| Criterion | Severity | ||
| Mild (grade I) | Moderate (grade II) | Severe (grade III) | |
| Onset of organ dysfunction | – | – | + |
| Response to medical treatment | + | – | – |
Grade I acute cholangitis
Grade I, or mild acute cholangitis, don't meet the criteria of neither grade II (moderate) nor grade III (severe) acute cholangitis. The patient responds to initial medical treatment.
Grade II acute cholangitis
Grade II, or moderate acute cholangitis, is characterized by the presence of any two of the following:
- Abnormal white blood cell (WBC) count: >12,000/mm3, <4,000/mm3
- Fever ≥39°C
- Age ≥75 years
- Elevated total bilirubin ≥5 mg/dl
- Decreased albumin level <0.7 x standard
Grade III acute cholangitis
Grade III, or severe acute cholangitis, is characterized by the onset of dysfunction in at least one of the following:
- Cardiovascular system: decreased blood pressure that necessitates the administration of dopamine (>5 μg/kg/min) or norepinephrine
- Neurological system: abnormal consciousness
- Respiratory system: PaO2/FiO2 ratio <300
- Renal system: serum creatinine >2.0 mg/dl, decreased urine output
- Hepatic system: PT-INR >1.5
- Hematological system: platelet count < 100,000/mm3
References
- ↑ 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 (2007). "Diagnostic criteria and severity assessment of acute cholangitis: Tokyo Guidelines". J Hepatobiliary Pancreat Surg. 14 (1): 52–8. doi:10.1007/s00534-006-1156-7. PMC 2784515. PMID 17252297.
- ↑ Zimmer V, Lammert F (June 2015). "Acute Bacterial Cholangitis". Viszeralmedizin. 31 (3): 166–72. doi:10.1159/000430965. PMC 4569195. PMID 26468310.
- ↑ Lee JG (September 2009). "Diagnosis and management of acute cholangitis". Nat Rev Gastroenterol Hepatol. 6 (9): 533–41. doi:10.1038/nrgastro.2009.126. PMID 19652653.
- ↑ Mayumi, T.; Someya, K.; Ootubo, H.; Takama, T.; Kido, T.; Kamezaki, F.; Yoshida, M.; Takada, T. (2013). "Progression of Tokyo Guidelines and Japanese Guidelines for management of acute cholangitis and cholecystitis". J UOEH. 35 (4): 249–57. PMID 24334691.
- ↑ Takada T, Strasberg SM, Solomkin JS, Pitt HA, Gomi H, Yoshida M, Mayumi T, Miura F, Gouma DJ, Garden OJ, Büchler MW, Kiriyama S, Yokoe M, Kimura Y, Tsuyuguchi T, Itoi T, Gabata T, Higuchi R, Okamoto K, Hata J, Murata A, Kusachi S, Windsor JA, Supe AN, Lee S, Chen XP, Yamashita Y, Hirata K, Inui K, Sumiyama Y (2013). "TG13: Updated Tokyo Guidelines for the management of acute cholangitis and cholecystitis". J Hepatobiliary Pancreat Sci. 20 (1): 1–7. doi:10.1007/s00534-012-0566-y. PMID 23307006.
- ↑ Dinc T, Kayilioglu SI, Coskun F (2017). "Evaluation and Comparison of Charcot's Triad and Tokyo Guidelines for the Diagnosis of Acute Cholangitis". Indian J Surg. 79 (5): 427–430. doi:10.1007/s12262-016-1512-z. PMID 29089703.