This is an unprecedented time. It is the dedication of healthcare workers that will lead us through this crisis. Thank you for everything you do.
COVID-19 Resource Center

      Calc Function

    • Calcs that help predict probability of a diseaseDiagnosis
    • Subcategory of 'Diagnosis' designed to be very sensitiveRule Out
    • Disease is diagnosed: prognosticate to guide treatmentPrognosis
    • Numerical inputs and outputsFormula
    • Med treatment and moreTreatment
    • Suggested protocolsAlgorithm

    Disease

    Select...

    Specialty

    Select...

    Chief Complaint

    Select...

    Organ System

    Select...

    Patent Pending

    Log In

    Show
    Forgot your password?
    Log In
    Or create a new account (it's free)

    Forgot Password?

    Enter your email address and we'll send you a link to reset your password.

    Get New Password

    Sign In Required

    To save favorites, you must log in.

    Creating an account is free, easy, and takes about 60 seconds.

    Already have an MDCalc account?

    Login to link your favorites and recently used calcs

    Show
    Forgot your password?
    Log In
    Or continue to Nuance

    Attention COACH STUDY participants:

    The principal investigators of the study request that you use the official version of the modified score here.

    Tokyo Guidelines for Acute Cholangitis 2018

    Provides diagnostic criteria and severity grading for acute cholangitis.
    When to Use
    Pearls/Pitfalls
    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
    No
    Yes
    No
    Yes
    Part B: Cholestasis
    No
    Yes
    No
    Yes
    Part C: Imaging
    No
    Yes
    No
    Yes

    Result:

    Please fill out required fields.

    Next Steps
    Evidence
    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

    Are you Dr. Fumihiko Miura? 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.
    Content Contributors
    Reviewed By
    • Lionel D'Souza, MBBS
    About the Creator
    Dr. Fumihiko Miura
    Are you Dr. Fumihiko Miura?
    Content Contributors
    Reviewed By
    • Lionel D'Souza, MBBS