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dc.contributor.authorHirota, Masahiko
dc.contributor.authorTakada, Tadahiro
dc.contributor.authorKawarada, Yoshifumi
dc.contributor.authorNimura, Yuji
dc.contributor.authorMiura, Fumihiko
dc.contributor.authorHirata, Koichi
dc.contributor.authorMayumi, Toshihiko
dc.contributor.authorYoshida, Masahiro
dc.contributor.authorStrasberg, Steven M
dc.contributor.authorPitt, Henry A
dc.contributor.authorGadacz, Thomas R
dc.contributor.authorde Santibanes, Eduardo
dc.contributor.authorGouma, Dirk J
dc.contributor.authorSolomkin, Joseph S
dc.contributor.authorBelghiti, Jacques
dc.contributor.authorNeuhaus, Horst
dc.contributor.authorFan, Sheung-Tat
dc.contributor.authorKer, Chen-Guo
dc.contributor.authorPadbury, Robert T
dc.contributor.authorLiau, Kui-Hin
dc.contributor.authorHilvano, Serafin C
dc.contributor.authorBelli, Giulio
dc.contributor.authorWindsor, John A
dc.contributor.authorDervenis, Christos
dc.contributor.authorBüchler, Markus W
dc.date.accessioned2010-09-24T22:03:19Z
dc.date.available2010-09-24T22:03:19Z
dc.date.issued2007-01-25en_US
dc.identifier.citationJ Hepatobiliary Pancreat Surg. 2007 Jan 30; 14(1):78-82en_US
dc.identifier.issn0944-1166en_US
dc.identifier.pmid17252300en_US
dc.identifier.doi10.1007/s00534-006-1159-4en_US
dc.identifier.urihttp://hdl.handle.net/10675.2/103
dc.description.abstractThe aim of this article is to propose new criteria for the diagnosis and severity assessment of acute cholecystitis, based on a systematic review of the literature and a consensus of experts. A working group reviewed articles with regard to the diagnosis and treatment of acute cholecystitis and extracted the best current available evidence. In addition to the evidence and face-to-face discussions, domestic consensus meetings were held by the experts in order to assess the results. A provisional outcome statement regarding the diagnostic criteria and criteria for severity assessment was discussed and finalized during an International Consensus Meeting held in Tokyo 2006. Patients exhibiting one of the local signs of inflammation, such as Murphy's sign, or a mass, pain or tenderness in the right upper quadrant, as well as one of the systemic signs of inflammation, such as fever, elevated white blood cell count, and elevated C-reactive protein level, are diagnosed as having acute cholecystitis. Patients in whom suspected clinical findings are confirmed by diagnostic imaging are also diagnosed with acute cholecystitis. The severity of acute cholecystitis is classified into three grades, mild (grade I), moderate (grade II), and severe (grade III). Grade I (mild acute cholecystitis) is defined as acute cholecystitis in a patient with no organ dysfunction and limited disease in the gallbladder, making cholecystectomy a low-risk procedure. Grade II (moderate acute cholecystitis) is associated with no organ dysfunction but there is extensive disease in the gallbladder, resulting in difficulty in safely performing a cholecystectomy. Grade II disease is usually characterized by an elevated white blood cell count; a palpable, tender mass in the right upper abdominal quadrant; disease duration of more than 72 h; and imaging studies indicating significant inflammatory changes in the gallbladder. Grade III (severe acute cholecystitis) is defined as acute cholecystitis with organ dysfunction.
dc.rightsThe PMC Open Access Subset is a relatively small part of the total collection of articles in PMC. Articles in the PMC Open Access Subset are still protected by copyright, but are made available under a Creative Commons or similar license that generally allows more liberal redistribution and reuse than a traditional copyrighted work. Please refer to the license statement in each article for specific terms of use. The license terms are not identical for all articles in this subset.en_US
dc.subject.meshCholecystitis, Acute / classification / diagnosisen_US
dc.subject.meshHumansen_US
dc.subject.meshMagnetic Resonance Imagingen_US
dc.subject.meshSeverity of Illness Indexen_US
dc.subject.meshTokyoen_US
dc.subject.meshTomography, X-Ray Computeden_US
dc.titleDiagnostic criteria and severity assessment of acute cholecystitis: Tokyo Guidelines.en_US
dc.typeJournal Articleen_US
dc.typePractice Guidelineen_US
dc.typeResearch Support, Non-U.S. Gov'ten_US
dc.identifier.pmcidPMC2784516en_US
dc.contributor.corporatenameDepartment of Surgeryen_US
refterms.dateFOA2019-04-09T16:18:36Z
html.description.abstractThe aim of this article is to propose new criteria for the diagnosis and severity assessment of acute cholecystitis, based on a systematic review of the literature and a consensus of experts. A working group reviewed articles with regard to the diagnosis and treatment of acute cholecystitis and extracted the best current available evidence. In addition to the evidence and face-to-face discussions, domestic consensus meetings were held by the experts in order to assess the results. A provisional outcome statement regarding the diagnostic criteria and criteria for severity assessment was discussed and finalized during an International Consensus Meeting held in Tokyo 2006. Patients exhibiting one of the local signs of inflammation, such as Murphy's sign, or a mass, pain or tenderness in the right upper quadrant, as well as one of the systemic signs of inflammation, such as fever, elevated white blood cell count, and elevated C-reactive protein level, are diagnosed as having acute cholecystitis. Patients in whom suspected clinical findings are confirmed by diagnostic imaging are also diagnosed with acute cholecystitis. The severity of acute cholecystitis is classified into three grades, mild (grade I), moderate (grade II), and severe (grade III). Grade I (mild acute cholecystitis) is defined as acute cholecystitis in a patient with no organ dysfunction and limited disease in the gallbladder, making cholecystectomy a low-risk procedure. Grade II (moderate acute cholecystitis) is associated with no organ dysfunction but there is extensive disease in the gallbladder, resulting in difficulty in safely performing a cholecystectomy. Grade II disease is usually characterized by an elevated white blood cell count; a palpable, tender mass in the right upper abdominal quadrant; disease duration of more than 72 h; and imaging studies indicating significant inflammatory changes in the gallbladder. Grade III (severe acute cholecystitis) is defined as acute cholecystitis with organ dysfunction.


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