Table 1 Classification of acute cholecystitis by the Tokyo guidelines 2013
Grade | Definition | |
|---|---|---|
I (Mild) | Acute cholecystitis that does not meet the criteria for Grade III or Grade II | |
Acute cholecystitis in a healthy patient with no organ dysfunction. Inflammatory changes in the gallbladder are mild, making cholecystectomy a safe and low-risk procedure. | ||
II (Moderate) | Grade II acute cholecystitis is associated with any one of the following conditions | |
1 | Elevated white blood cell count (>18,000/mm4) | |
2 | Palpable tender mass in the right upper abdominal quadrant | |
3 | Duration of complaints > 72 h | |
4 | Marked local inflammation (gangrenous cholecystitis, pericholecystic abscess, hepatic abscess, biliary peritonitis, emphysematous cholecystitis) | |
III (Severe) | Grade III acute cholecystitis associated with dysfunction of any one of the following organs/systems | |
1 | Cardiovascular dysfunction defined as hypotension requiring treatment with ≥ 5 μg/kg per min of dopamine or any dose of norepinephrine | |
2 | Neurologic dysfunction defined as decreased level of consciousness | |
3 | Respiratory dysfunction defined as a PaO2/FiO2 ratio of <300 | |
4 | Renal dysfunction defined as oliguria or creatinine level of > 2.0 mg/dl | |
5 | Hepatic dysfunction defined as PT-INR of > 1.5 | |
6 | Hematologic dysfunction defined as platelet count of <100,000/mm3 | |