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    Tokyo Guidelines for Acute Cholecystitis 2018

    Provides diagnostic criteria and severity grading for acute cholecystitis.
    When to Use
    Pearls/Pitfalls
    Why Use

    Use in patients with suspected acute cholecystitis (i.e., right upper quadrant tenderness, liver enzyme abnormalities, imaging findings characteristic of acute cholecystitis).

    • More extensively validated in non-US populations.

    • Conditions such as acute hepatitis and acute cholangitis may have some similarities in presentation and should be excluded, as well as chronic cholecystitis.

    • Measurement of serum procalcitonin has not been shown to be useful for diagnosis or severity grading.

    • If ultrasound is non-diagnostic, cholescintigraphy (HIDA) has a high sensitivity and specificity for diagnosis of acute cholecystitis. CT has low specificity.

    • Laparoscopic cholecystectomy (LC) to treat moderate- and severe-grade acute cholecystitis (Grades II and III) has better clinical outcomes at high volume centers.

    • The guidelines recommend using the Charlson Comorbidity Index (CCI) and ASA Physical Status to stratify patients into low risk and high risk surgical candidates.

    Objectively guides diagnosis and management of patients with acute cholecystitis in terms of early or delayed surgical intervention, early or delayed gallbladder drainage, and antibiotic choice and duration.

    Part A: Local Signs of Inflammation
    No
    Yes
    No
    Yes
    Part B: Systemic Signs of Inflammation
    No
    Yes
    No
    Yes
    No
    Yes
    Part C: Imaging
    No
    Yes

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    Evidence
    Creator Insights
    Dr. Masamichi Yokoe

    About the Creator

    Masamichi Yokoe, MD, is a physician in the internal medicine department at Nagoya Daini Red Cross Hospital in Honshu, Japan. Dr. Yokoe's primary research is focused on management of acute cholangitis and cholecystitis.

    To view Dr. Masamichi Yokoe's publications, visit PubMed

    Are you Dr. Masamichi Yokoe? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
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