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Severity of acute cholecystitis

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

A method for classification of severity acute cholecystitis has been suggested:

  • grade III (severe) acute cholecystitis
    • associated with dysfunction of any one of the following organs/systems:
      • cardiovascular dysfunction - hypotension requiring treatment with dopamine ≥5 µg/kg per min, or any dose of norepinephrine
      • neurological dysfunction - decreased level of consciousness
      • respiratory dysfunction - PaO2/FiO2 ratio <300
      • renal dysfunction - oliguria, creatinine >2.0 mg/dl
      • hepatic dysfunction - PT-INR>1.5
      • hematological dysfunction - platelet count <100,000/mm3
  • grade II (moderate) acute cholecystitis
    • associated with any one of the following conditions:
      • elevated white blood cell count (>18,000/mm3)
      • palpable tender mass in the right upper abdominal quadrant
      • duration of complaints >72 h
      • marked local inflammation (gangrenous cholecystitis, pericholecystic abscess, hepatic abscess, biliary peritonitis, emphysematous cholecystitis)
  • grade I (mild) acute cholecystitis
    • does not meet the criteria of 'Grade III' or 'Grade II' acute cholecystitis
    • grade I can also be defined as acute cholecystitis in a healthy patient with no organ dysfunction and mild inflammatory changes in the gallbladder, making cholecystectomy a safe and low-risk operative procedure (1)

Reference:

  1. Yokoe M, et al.Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci. 2018 Jan;25(1):41-54. doi: 10.1002/jhbp.515. Epub 2018 Jan 9. PMID: 29032636.

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