What are the Tokyo Guidelines for diagnosis of acute cholecystitis?

Updated: Jan 18, 2017
  • Author: Peter A D Steel, MBBS, MA; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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The "Tokyo guidelines" were published in 2007 and updated in 2013. They are a set of clinical and radiologic diagnostic criteria for acute cholecystitis created to address the controversy regarding the optimal criteria for clinical diagnosis. [21] Patients exhibiting one of the local signs of inflammation, such as Murphy sign (specificity, 79-96%; sensitivity, 50-60% [21] ), or a mass/pain/tenderness in the right upper quadrant, as well as one of the systemic signs of inflammation, such as fever, elevated white blood cell (WBC) count, and elevated C-reactive protein level, are diagnosed as having acute cholecystitis. [22] Imaging findings characteristic of acute cholecystitis confirm the diagnosis. [21]

Once the diagnosis of acute cholecystitis is made, it usually is treated by hospitalization. This may include medical and/or surgical therapy. Some patients may be treated as outpatients.

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