Cholangitis classification: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
 
(20 intermediate revisions by 7 users not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
{{Cholangitis}}
{{Cholangitis}}
{{CMG}}; {{AE}} {{VR}} and {{FH}}
{{CMG}}; {{AE}} {{ADS}}, {{VR}}, {{FH}}


==Overview==
==Overview==
Acute cholangitis is classified into grade I, II or III, depending on the severity of the condition.
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 or 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>  
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)
*Severe (grade III)
*Severe (grade III)


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 | month = Dec | year = 2013 | doi =  | PMID = 24334691 }}</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>
====Grade III Acute Cholangitis====
{|
Grade III or severe acute cholangitis is characterized by the onset of dysfunction in at least one of the following:
! colspan="4" style="background:#4479BA; color: #FFFFFF;" align="center" |Severity assessment of cholangitis
*Cardiovascular system: decreased blood pressure that necessitate the administration of dopamine (>5 μg/kg/min) or norepinephrine
|-
*Neurological system: abnormal consciousness
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Criterion
*Respiratory system: PaO2/FiO2 ratio <300
! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Severity
*Renal system: serum creatinine >2.0 mg/dl, decreased urine output
|-
*Hepatic system: PT-INR >1.5
! style="background:#4479BA; color: #FFFFFF;" align="center" |Mild (grade I)
*Hematological system: platelet count < 100,000/mm<sup>3</sup>
! 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 Acute Cholangitis====
====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
* Elevated total bilirubin ≥5 mg/dl
* Elevated total [[bilirubin]] ≥5 mg/dl
* Decreased albumin level <0.7 x STD
* Decreased [[albumin]] level <0.7 x standard


====Grade I Acute Cholangitis====
====Grade III acute cholangitis====
Grade I or mild acute cholangitis does not meet the criteria of neither grade II (moderate) or grade III (severe) 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|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==
{{Reflist|2}}
{{Reflist|2}}


[[Category:Disease]]
{{WikiDoc Help Menu}}
{{WikiDoc Sources}}
 
[[Category:Gastroenterology]]
[[Category:Gastroenterology]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
 
[[Category:FinalQCRequired]]
{{WikiDoc Help Menu}}
[[Category:Disease]]
{{WikiDoc Sources}}
[[Category:Up-To-Date]]
[[Category:Infectious disease]]
[[Category:Surgery]]

Latest revision as of 16:52, 27 October 2020

Cholangitis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Cholangitis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X Ray

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Cholangitis classification On the Web

Most recent articles

cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Cholangitis classification

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Cholangitis classification

CDC on Cholangitis classification

Cholangitis classification in the news

Blogs on Cholangitis classification

Directions to Hospitals Treating Cholangitis

Risk calculators and risk factors for Cholangitis classification

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:

Grade III acute cholangitis

Grade III, or severe acute cholangitis, is characterized by the onset of dysfunction in at least one of the following:

References

  1. ↑ 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.
  2. ↑ Zimmer V, Lammert F (June 2015). "Acute Bacterial Cholangitis". Viszeralmedizin. 31 (3): 166–72. doi:10.1159/000430965. PMC 4569195. PMID 26468310.
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ 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.
  6. ↑ 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.


Template:WikiDoc Sources

Retrieved from "https://www.wikidoc.org/index.php?title=Cholangitis_classification&oldid=1671158"