Criteria

Sonographic criteria of acute cholecystitis[42]

  • Pericholecystic fluid

  • Distended gallbladder

  • Thickened gallbladder wall (≥4 mm)

  • Gallstones

  • Positive sonographic Murphy sign.

Diagnostic criteria for acute cholecystitis[35]

A. Local signs of inflammation

  • Murphy sign

  • Right upper quadrant mass/pain/tenderness.

B. Systemic signs of inflammation

  • Fever

  • Elevated C-reactive protein

  • Elevated WBC.

C. Imaging findings: characteristic of the condition.

Suspected diagnosis: one finding from section A, plus one finding from section B.

Definite diagnosis: one finding from section A, plus one finding from section B, plus characteristic imaging findings.

Severity assessment criteria for acute cholecystitis[35]

Mild (grade I)

  • Healthy patient with no organ dysfunction and mild inflammatory changes in the gallbladder, making cholecystectomy a safe and low-risk operative procedure.

Moderate (grade II)

  • Associated with any one of the following conditions:

    • Elevated white blood cell count (>18,000/microliter)

    • Palpable tender mass in the right upper abdominal quadrant

    • Duration of complaints >72 hours

    • Marked local inflammation (gangrenous cholecystitis, pericholecystic abscess, hepatic abscess, biliary peritonitis, emphysematous cholecystitis).

Severe (grade III)

  • Associated with dysfunction of any one of the following organs/systems:

    • Cardiovascular dysfunction (hypotension requiring treatment with dopamine beyond a certain dose, or any dose of norepinephrine)

    • Neurologic dysfunction (decreased level of consciousness)

    • Respiratory dysfunction (PaO2/FiO2 ratio <300)

    • Renal dysfunction (oliguria, creatinine >2.0 mg/dL)

    • Hepatic dysfunction (INR >1.5)

    • Hematologic dysfunction (platelet count <100,000/microliter).

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