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    Patent Pending

    Tokyo Guidelines for Acute Cholangitis 2018

    Provides diagnostic criteria and severity grading for acute cholangitis.
    When to Use
    Why Use

    Use in patients with suspected acute cholangitis (i.e., fever, jaundice, right upper quadrant pain, altered mental status, and/or hemodynamic instability).

    • More extensively studied in non-US populations.

    • Conditions such as acute hepatitis and acute cholecystitis may have some similarities in presentation and should be ruled out.

    • Although MRI and MRCP have the highest sensitivity/specificity for bile duct dilation, abdominal US followed by CT abdomen are more readily available and cost-effective, and thus should be performed initially.

    • Procalcitonin is useful in assessing the severity of cholangitis, not in the diagnosis.

    • For patients with grade II-III (moderate to severe) cholangitis, transfer to a hospital that can perform biliary drainage and provide ICU level care is recommended.

    • Objectively guides diagnosis and management of patients with acute cholangitis in terms of timing and need for biliary drainage and supportive care.

    • Charcot’s triad (fever, right upper quadrant pain, jaundice) has high specificity but low sensitivity for acute cholangitis (Kiriyama et al 2017).

    Part A: Systemic Inflammation
    Part B: Cholestasis
    Part C: Imaging

    Diagnostic Result:

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    Creator Insights
    Dr. Fumihiko Miura

    About the Creator

    Fumihiko Miura, MD, is a physician in the department of surgery at the Teikyo University School of Medicine in Tokyo, Japan. Dr. Miura's primary research is focused on the grading and management of acute cholangitis.

    To view Dr. Fumihiko Miura's publications, visit PubMed

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    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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