🟡 Acute Cholangitis Severity & Management (TG18)
UseUse to assign TG18 severity (organ dysfunction or moderate criteria) and time biliary drainage, from urgent i…
SourceKiriyama S, et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholang…
This-shift next steps
After scoring: open the scene pack, peer scores, and the matching pathway. Local reference — no HIS write.
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Methodology · worked example, guidelines & full notes
Even mild (Grade I) cholangitis proceeds to drainage if antibiotics fail to control it within 24 hours. (original synthesis · not guideline verbatim)
When to use
Use to assign TG18 severity (organ dysfunction or moderate criteria) and time biliary drainage, from urgent in Grade III to response-based in Grade I.
How it works
Grade III = any new organ dysfunction → urgent drainage once stable. Grade II = ≥ 2 moderate criteria → early drainage. Grade I → antibiotics, drainage if no response within 24 h. ERCP preferred, PTBD if not feasible.
Key points
- Even mild (Grade I) cholangitis proceeds to drainage if antibiotics fail to control it within 24 hours. (original synthesis · not guideline verbatim)
- Empiric antibiotics target Gram-negative Enterobacteriaceae, started as early as possible in septic shock.
- Common-bile-duct stones are the leading cause, treated during or after drainage.
References
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Any new-onset organ dysfunction (cardiovascular/neurologic/respiratory/renal/hepatic/hematologic) | Present |
|---|---|
| Number of moderate criteria met (of 5) | 1 |
→SeverityGrade III (severe)
- Biliary drainage：Urgent biliary drainage once hemodynamically stable (ERCP preferred, PTBD if not feasible) + organ support
- Antibiotics：Immediate empiric broad-spectrum antibiotics covering Gram-negative Enterobacteriaceae (as early as possible in septic shock; timing without shock [pending update]); course can be shortened after successful drainage ([pending update], or a few more days after source control)
- Cultures/etiology：Obtain blood and bile cultures; the common cause is common-bile-duct stones, then benign/malignant strictures; treat the cause during or after drainage
| Any new-onset organ dysfunction (cardiovascular/neurologic/respiratory/renal/hepatic/hematologic) | Absent |
|---|---|
| Number of moderate criteria met (of 5) | 1 |
→SeverityGrade I (mild)
- Biliary drainage：Antibiotics + support; if no response to initial treatment within 24 h, biliary drainage promptly
- Antibiotics：Immediate empiric broad-spectrum antibiotics covering Gram-negative Enterobacteriaceae (as early as possible in septic shock; timing without shock [pending update]); course can be shortened after successful drainage ([pending update], or a few more days after source control)
- Cultures/etiology：Obtain blood and bile cultures; the common cause is common-bile-duct stones, then benign/malignant strictures; treat the cause during or after drainage
Verification & sources · governance
FAQ
Frequently asked questions
- What are the limits and cautions when using Acute Cholangitis Severity & Management (TG18)?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- Does Acute Cholangitis Severity & Management (TG18) upload patient data? Where is it calculated?
- Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.
- How is Acute Cholangitis Severity & Management (TG18) calculated in practice? Can you show a worked example?
- Inputs: Any new-onset organ dysfunction (cardiovascular/neurologic/respiratory/renal/hepatic/hematologic) Present, Number of moderate criteria met (of 5) 1 → Result: Severity Grade III (severe)（Biliary drainage: Urgent biliary drainage once hemodynamically stable (ERCP preferred, PTBD if not feasible) + organ support, Antibiotics: Immediate empiric broad-spectrum antibiotics covering Gram-negative Enterobacteriaceae (as early as possible in septic shock; timing without shock [pending update]); course can be shortened after successful drainage ([pending update], or a few more days after source control), Cultures/etiology: Obtain blood and bile cultures; the common cause is common-bile-duct stones, then benign/malignant strictures; treat the cause during or after drainage） Inputs: Any new-onset organ dysfunction (cardiovascular/neurologic/respiratory/renal/hepatic/hematologic) Absent, Number of moderate criteria met (of 5) 1 → Result: Severity Grade I (mild)（Biliary drainage: Antibiotics + support; if no response to initial treatment within 24 h, biliary drainage promptly, Antibiotics: Immediate empiric broad-spectrum antibiotics covering Gram-negative Enterobacteriaceae (as early as possible in septic shock; timing without shock [pending update]); course can be shortened after successful drainage ([pending update], or a few more days after source control), Cultures/etiology: Obtain blood and bile cultures; the common cause is common-bile-duct stones, then benign/malignant strictures; treat the cause during or after drainage）