2018 Volume 32 Issue 1 Pages 160-168
Acute cholangitis (AC) is a disease in which acute inflammation of the biliary tract develops, and early diagnosis, appropriate severity assessment and adequate treatment of are necessary. The Tokyo Guidelines 2013 (TG13) provide a consistent basis for the management of AC. AC is diagnosed when cholestasis and inflammation based on clinical signs or blood tests together with biliary tract manifestations based on diagnostic imaging findings are present. According to TG13, when organ failure is present the severity of AC is classified as grade III. When any two of five predictors are present AC is will classify as Grade II. All others cases are classified as Grade I. Since even some mild case of AC progress to severe cases during their course, repeated severity grading is necessary. Procalcitonin has been reported to be a useful biomarker to predict grade III AC. Based on the Japanese Association for Acute Medicine criteria, disseminated intravascular coagulation (DIC) has been found to occur as a complication even in AC cases assessed as Grade I or Grade II.
