Acute Cholecystitis Severity (Tokyo Guidelines TG18)
Acute cholecystitis severity grade: Grade III if any one new-onset organ dysfunction; Grade II if any one of WBC > 18,000/mm3, a palpable tender RUQ mass, duration > 72 h, or marked local inflammation; Grade I otherwise.
Open the calculator → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- Duration of complaints > 72 h
- Yes
Result: Grade II (moderate) acute cholecystitis: any one moderate criterion (here duration > 72 h) makes it Grade II.
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What the result means
- I
- Mild: no organ dysfunction and no moderate criteria; cholecystectomy is a safe, low-risk procedure.
- II
- Moderate: any one of WBC > 18,000, a palpable tender RUQ mass, duration > 72 h, or marked local inflammation.
- III
- Severe: any one new-onset organ dysfunction (cardiovascular, neurological, respiratory, renal, hepatic, or hematological).
What you enter
- Cardiovascular dysfunction (dopamine >= 5 ug/kg/min or any norepinephrine)
- Neurological dysfunction (decreased level of consciousness)
- Respiratory dysfunction (PaO2/FiO2 ratio < 300)
- Renal dysfunction (oliguria or serum creatinine > 2.0 mg/dL)
- Hepatic dysfunction (PT-INR > 1.5)
- Hematological dysfunction (platelet count < 100,000/mm3)
- Elevated WBC count (> 18,000/mm3)
- Palpable tender mass in the right upper abdominal quadrant
The other 2 fields
- Duration of complaints > 72 h
- Marked local inflammation (gangrenous/emphysematous cholecystitis, pericholecystic or hepatic abscess, biliary peritonitis)
How this is calculated
Miura F, Okamoto K, Takada T, et al. Tokyo Guidelines 2018: initial management of acute biliary infection and flowchart for acute cholangitis. J Hepatobiliary Pancreat Sci. 2018;25(1):31-40 (Table 4, cited from Yokoe et al.). Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.