This document provides an overview of autoimmune hepatitis. It discusses the historical background, epidemiology, pathogenesis, clinical presentation, diagnosis, treatment and prognosis. Some key points:
- Autoimmune hepatitis is a chronic inflammatory liver condition characterized by interface hepatitis on biopsy and circulating autoantibodies.
- It is diagnosed based on clinical features, lab abnormalities and exclusion of other causes of chronic hepatitis.
- Treatment involves immunosuppression with corticosteroids (prednisone) with or without azathioprine to induce and maintain remission.
- Prognosis is generally good for patients who respond to treatment but some may require liver transplantation if progression to cirrhosis occurs.
This document provides an overview of renal replacement therapies used in critical care settings. It discusses some of the key questions around when and how to use these therapies for acute kidney injury (AKI) patients. While there is no definitive evidence that answers all the questions, the literature suggests starting renal replacement therapy early according to RIFLE criteria and aiming for a minimum dose of 35 ml/kg/hr. Choice of therapy mode (intermittent vs continuous) may not be as important as ensuring adequate dosing. Further research is still needed to fully understand how to optimize outcomes for AKI patients requiring renal replacement therapy.
IgG4-related disease is a chronic fibroinflammatory condition characterized by tumefactive lesions rich in IgG4-positive plasma cells and storiform fibrosis. It commonly involves the pancreas, salivary glands, lacrimal glands, and retroperitoneum. Diagnosis involves elevated serum IgG4 levels, histopathological examination showing lymphoplasmacytic infiltrate and fibrosis, and often fulfilling clinical diagnostic criteria. Differential diagnosis includes cancers, infections and other diseases. Treatment involves glucocorticoids as first line with potential use of immunosuppressants. Relapse is common requiring glucocorticoid tapers or maintenance therapy.
This document provides a case study on a 75-year old woman admitted with abdominal pain who was diagnosed with acute gallstone pancreatitis. The summary is:
1) The patient presented with intermittent right upper quadrant abdominal pain for 6 weeks along with nausea and vomiting in the past 24 hours. Laboratory tests revealed elevated pancreatic enzymes and ultrasound showed gallstones.
2) The case was identified as acute gallstone pancreatitis, which occurs when a gallstone lodges in the pancreatic duct, causing the pancreatic juices to become trapped and inflamed.
3) The anatomy of the gallbladder and pancreas was described, noting their roles in bile and enzyme production and drainage into the small intestine.
Thyroid dysfunction and insulin resistance journal ppt.pptxSyedFurqan30
This study examined the relationship between thyroid dysfunction and insulin resistance by comparing insulin resistance levels in hyperthyroid, hypothyroid, and euthyroid patients. The results showed that hypothyroid patients had the highest levels of insulin and insulin resistance as measured by HOMA-IR. Hyperthyroid patients also had higher levels than euthyroid patients. Specifically, hypothyroid patients showed a positive correlation between TSH levels and insulin resistance, while hyperthyroid patients showed a correlation between FT3 levels and insulin resistance. The study concluded that thyroid disorders are associated with greater insulin resistance and risk of cardiovascular and metabolic abnormalities.
Journal dr abdulfarey 2017 paediatric fluid resuscitationZahra Khan
1) The study evaluated the effects of fluid bolus resuscitation in African children with severe febrile illness and impaired perfusion. It found that saline or albumin boluses increased 48-hour mortality compared to maintenance fluids alone.
2) Mortality rates at 48 hours were 10.6% and 10.5% for the albumin and saline bolus groups respectively, and 7.3% for the maintenance fluid group. Most deaths occurred within 24 hours.
3) The study demonstrates that fluid bolus resuscitation may do more harm than good for severely ill children in African hospitals and raises questions about its use in other settings as well.
1. A 35-year-old male presented with fever and body pain and was prescribed chloroquine by a private practitioner. After several days, the patient developed palpitations, weakness, muscle cramps and constipation.
2. Upon admission to the hospital, the patient was found to have hypokalemia which was determined to be caused by chloroquine overdose based on the Naranjo Scale assessment.
3. The patient recovered after being treated for hypokalemia and was discharged from the hospital.
This document provides an overview of autoimmune hepatitis. It discusses the historical background, epidemiology, pathogenesis, clinical presentation, diagnosis, treatment and prognosis. Some key points:
- Autoimmune hepatitis is a chronic inflammatory liver condition characterized by interface hepatitis on biopsy and circulating autoantibodies.
- It is diagnosed based on clinical features, lab abnormalities and exclusion of other causes of chronic hepatitis.
- Treatment involves immunosuppression with corticosteroids (prednisone) with or without azathioprine to induce and maintain remission.
- Prognosis is generally good for patients who respond to treatment but some may require liver transplantation if progression to cirrhosis occurs.
This document provides an overview of renal replacement therapies used in critical care settings. It discusses some of the key questions around when and how to use these therapies for acute kidney injury (AKI) patients. While there is no definitive evidence that answers all the questions, the literature suggests starting renal replacement therapy early according to RIFLE criteria and aiming for a minimum dose of 35 ml/kg/hr. Choice of therapy mode (intermittent vs continuous) may not be as important as ensuring adequate dosing. Further research is still needed to fully understand how to optimize outcomes for AKI patients requiring renal replacement therapy.
IgG4-related disease is a chronic fibroinflammatory condition characterized by tumefactive lesions rich in IgG4-positive plasma cells and storiform fibrosis. It commonly involves the pancreas, salivary glands, lacrimal glands, and retroperitoneum. Diagnosis involves elevated serum IgG4 levels, histopathological examination showing lymphoplasmacytic infiltrate and fibrosis, and often fulfilling clinical diagnostic criteria. Differential diagnosis includes cancers, infections and other diseases. Treatment involves glucocorticoids as first line with potential use of immunosuppressants. Relapse is common requiring glucocorticoid tapers or maintenance therapy.
This document provides a case study on a 75-year old woman admitted with abdominal pain who was diagnosed with acute gallstone pancreatitis. The summary is:
1) The patient presented with intermittent right upper quadrant abdominal pain for 6 weeks along with nausea and vomiting in the past 24 hours. Laboratory tests revealed elevated pancreatic enzymes and ultrasound showed gallstones.
2) The case was identified as acute gallstone pancreatitis, which occurs when a gallstone lodges in the pancreatic duct, causing the pancreatic juices to become trapped and inflamed.
3) The anatomy of the gallbladder and pancreas was described, noting their roles in bile and enzyme production and drainage into the small intestine.
Thyroid dysfunction and insulin resistance journal ppt.pptxSyedFurqan30
This study examined the relationship between thyroid dysfunction and insulin resistance by comparing insulin resistance levels in hyperthyroid, hypothyroid, and euthyroid patients. The results showed that hypothyroid patients had the highest levels of insulin and insulin resistance as measured by HOMA-IR. Hyperthyroid patients also had higher levels than euthyroid patients. Specifically, hypothyroid patients showed a positive correlation between TSH levels and insulin resistance, while hyperthyroid patients showed a correlation between FT3 levels and insulin resistance. The study concluded that thyroid disorders are associated with greater insulin resistance and risk of cardiovascular and metabolic abnormalities.
Journal dr abdulfarey 2017 paediatric fluid resuscitationZahra Khan
1) The study evaluated the effects of fluid bolus resuscitation in African children with severe febrile illness and impaired perfusion. It found that saline or albumin boluses increased 48-hour mortality compared to maintenance fluids alone.
2) Mortality rates at 48 hours were 10.6% and 10.5% for the albumin and saline bolus groups respectively, and 7.3% for the maintenance fluid group. Most deaths occurred within 24 hours.
3) The study demonstrates that fluid bolus resuscitation may do more harm than good for severely ill children in African hospitals and raises questions about its use in other settings as well.
1. A 35-year-old male presented with fever and body pain and was prescribed chloroquine by a private practitioner. After several days, the patient developed palpitations, weakness, muscle cramps and constipation.
2. Upon admission to the hospital, the patient was found to have hypokalemia which was determined to be caused by chloroquine overdose based on the Naranjo Scale assessment.
3. The patient recovered after being treated for hypokalemia and was discharged from the hospital.
This document provides information on gout and hyperuricemia. It discusses the pathophysiology of gout, including how uric acid crystals form in the joints and cause inflammation. It also covers risk factors, clinical presentation, diagnosis, and treatment approaches. Treatment involves acute relief of gout attacks with medications like NSAIDs or colchicine, as well as long-term urate-lowering therapy with drugs like allopurinol or febuxostat to prevent future attacks by lowering uric acid levels.
The document discusses different types of shock including their causes, pathogenesis, and management. It defines shock as an imbalance between oxygen supply and demand resulting in organ dysfunction. The main types are distributive, cardiogenic, obstructive, and hypovolemic shock. Septic shock is discussed in depth including its pathogenesis involving an inflammatory response to infection, diagnostic criteria using SOFA and qSOFA scores, and elements of care including resuscitation, infection control, and supportive therapies. Cardiogenic shock is defined as a low cardiac output state resulting from various cardiac causes such as myocardial infarction. Hypovolemic shock reduces cardiac output through a decrease in preload from losses such as hemorrhage.
The document provides information about peritonitis, including:
- Causes of peritonitis including bacterial, chemical, allergic, traumatic, ischemic, and miscellaneous causes.
- Acute bacterial peritonitis can be caused by gastrointestinal perforation, transmural translocation without perforation, exogenous contamination, or hematogenous spread.
- Common microorganisms involved in peritonitis include E. coli, streptococci, bacteroides, clostridium, and klebsiella from gastrointestinal sources, and other microbes from other sources.
- Defense mechanisms against peritonitis include leukocyte-attracting mechanisms, killing mechanisms, sequestration mechanisms
Systemic therapies such as targeted agents (TKIs) and immune checkpoint inhibitors are increasingly used to treat advanced hepatocellular carcinoma (HCC). These therapies can cause adverse events that require careful management. TKIs commonly cause hand-foot skin reactions, which are graded based on severity from 1-3. Management involves prophylaxis like moisturizing and avoiding friction, along with topical steroids and potentially dose reductions. Immune checkpoint inhibitors can cause immune-related adverse events affecting many organ systems from 1-4 based on severity. Most grade 1-2 events are managed with corticosteroids and holding immunotherapy, while higher grades often require high-dose steroids, other immunosuppression, and potentially discontin
Thyroid storm is a life-threatening syndrome that results from an acute exacerbation of thyrotoxicosis. Prevention, prompt recognition, and appropriate intervention as discussed herein are key to the prevention of death and morbidity in affected patients. I hope you find it educating as well as enlightening.
This document discusses sepsis and septic shock and provides guidelines for management. It defines sepsis as a systemic inflammatory response to infection and outlines the sepsis spectrum from sepsis to septic shock. It describes the typical host immune response and how an uncontrolled response can lead to systemic effects. Clinical presentation, diagnosis, bacteriology, and management including initial resuscitation, antimicrobial therapy and treatment duration are covered. Treatment aims to rapidly identify and treat the infection while stabilizing the patient and preventing further progression along the sepsis spectrum.
Serum magnesium level in children with bronchial asthma Azad Haleem
- The study aimed to determine the prevalence of hypomagnesemia (low magnesium levels) among asthmatic children compared to healthy controls.
- The mean serum magnesium level was found to be significantly lower in asthmatic children (1.91 mg/dL) than in healthy controls (2.03 mg/dL).
- Within the asthmatic group, serum magnesium levels decreased with increased asthma severity and inversely correlated with duration of asthma, though not significantly.
- The study concluded that asthmatic children have higher risk of magnesium deficiency and supplementation may help improve asthma outcomes.
This document summarizes the current state of anemia treatment in chronic kidney disease (CKD) patients. It discusses the magnitude of the problem, clinical management including use of erythropoiesis-stimulating agents (ESAs), and future therapies. ESAs are currently the mainstay of treatment but have limitations like requiring high doses and increased risks at higher hemoglobin levels. Newer approaches being researched include stabilizing hypoxia-inducible factor to stimulate endogenous erythropoietin production, modulating the iron-regulating hormone hepcidin, and gene therapy to introduce the erythropoietin gene directly.
The document discusses the importance of preoperative evaluation and optimization of patient health before surgery. The key purposes are to document medical conditions requiring surgery, assess overall health status, uncover hidden conditions that could cause problems during or after surgery, determine perioperative risk, and develop an appropriate perioperative care plan. This involves a thorough medical history, physical exam, and laboratory tests to evaluate organ function and minimize surgical risks. The goal is to reduce postoperative complications and facilitate a quick recovery.
Presentation on Sarcoidosis by S.K Jindal | Jindal Chest Clinic, ChandigarhJindal Chest Clinic
When the immune system overreacts, granulomas are formed, leading to a condition known as sarcoidosis. This disorder can cause mild to severe symptoms, or no symptoms at all. This Presentation describes sarcoidosis and gives an overview on Sarcoidosis including causes, symptoms, diagnosis, complications, supplements for sacrcoidosis, and treatment strategies. For more information, please contact us: 9779030507.
This document outlines critical care nutrition and metabolic response to stress and injury. It discusses how critical illness leads to catabolism and increased nutritional needs. Early enteral nutrition is preferred over total parenteral nutrition when possible due to lower risks of infection. Glutamine supplementation, especially at higher intravenous doses, may reduce mortality, infections, and length of stay in critically ill patients.
This document discusses the evolution of treatments for acute ischemic stroke caused by large vessel occlusion over the past three decades. It describes the development of intravenous thrombolysis using alteplase, including early safety trials, phase 3 efficacy trials, and limitations. It also discusses the emergence of endovascular therapies such as mechanical thrombectomy and the importance of neuroimaging such as CT and CT perfusion in selecting appropriate patients. The role of collateral circulation and a "tissue window" approach are also highlighted.
The document discusses steroids used in pediatrics. It covers the anatomy and physiology of the adrenal glands, steroid biosynthesis and the HPA axis. It compares steroid preparations and their potency. The actions, adverse effects, and uses of steroids in neonates and older children are described. Prevention and treatment of side effects are also covered.
Polymyositis as an Extra-Intestinal Manifestation of Ulcerative Colitis in a ...merdaci dhia elhak
A 28-year-old woman with a history of ulcerative colitis presented with muscle weakness, myalgias, and constitutional symptoms. Tests found elevated muscle enzymes and inflammation on muscle biopsy. She was diagnosed with polymyositis, a rare extra-intestinal manifestation of ulcerative colitis. Treatment with steroids and azathioprine improved her symptoms. While disease activity is not required, extra-intestinal manifestations like polymyositis should be considered in ulcerative colitis patients with muscle symptoms. Both conditions responded well to immunosuppressive therapy.
This patient presented with multiple symptoms including loose motions, blisters, cough, shortness of breath, abdominal fullness, and limb swelling. Laboratory tests found hypothyroidism, hypokalemia, anemia, and leukocytosis. Sputum culture grew Klebsiella pneumoniae and Acinetobacter species. The patient was diagnosed with Addison's disease, hypothyroidism, acute gastroenteritis caused by Giardia, iatrogenic Cushing's syndrome and pneumonia. The patient has a history of taking hydrocortisone, fludrocortisone, thyroxine, and prednisone for Addison's disease and hypothyroidism treatment, but developed Cushing's
Multitarget Therapy for InductionTreatment of Lupus Nephritis, Moh'd sharshirMoh'd sharshir
This study compared the efficacy and safety of a multitarget regimen consisting of tacrolimus, mycophenolate mofetil (MMF), and steroids to intravenous cyclophosphamide (IVCY) and steroids as induction therapy for lupus nephritis (LN). 368 patients with LN were randomly assigned to receive either the multitarget regimen or IVCY. The multitarget regimen resulted in significantly higher rates of complete remission and overall response. Adverse events were similar between groups. The multitarget regimen was found to be superior to IVCY as induction therapy for LN.
A 11-year old girl presented with insidious onset muscle weakness and pain over the past 3 months, limiting her ability to perform activities like getting up from a chair or climbing stairs. She also had fever, difficulty swallowing and speaking, and a rash around her eyes. On examination, she had a temperature of 40.1°C, pallor, swollen lymph nodes in her neck, a heliotrope rash above her eyelids, and difficulty raising her arms above her head due to proximal muscle tenderness and weakness. She was diagnosed with juvenile dermatomyositis based on her clinical features and responsive to treatment with corticosteroids.
Nephritis is a inflammation of kidney .
It is classified into various types like lupus nephritis ,interstitial nephritis , glomerulonephritis ,pyelonephritis.
Lupus nephritis is an inflammation of kidney due to autoimmune disorder named as lupus .
It is inflammation of lower urinary tract .
post operative complications MEDICAL.pptxasispodar
The document discusses postoperative complications, their prevention and management. Some key points:
- Surgical patients are at risk of complications during and after surgery, ranging from minor to serious. The risk depends on the surgery, patient health, and care. Complications increase costs, length of stay, and suffering.
- Prevention techniques include pre-assessment, managing pre-existing conditions, proper antibiotics and analgesia, early mobilization, and maintaining asepsis during surgery.
- Management of complications involves respiratory care like deep breathing exercises; circulatory care like ambulation; pain control; fluid and electrolyte monitoring; encouraging activity; and wound care like inspection and dressing.
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Systemic therapies such as targeted agents (TKIs) and immune checkpoint inhibitors are increasingly used to treat advanced hepatocellular carcinoma (HCC). These therapies can cause adverse events that require careful management. TKIs commonly cause hand-foot skin reactions, which are graded based on severity from 1-3. Management involves prophylaxis like moisturizing and avoiding friction, along with topical steroids and potentially dose reductions. Immune checkpoint inhibitors can cause immune-related adverse events affecting many organ systems from 1-4 based on severity. Most grade 1-2 events are managed with corticosteroids and holding immunotherapy, while higher grades often require high-dose steroids, other immunosuppression, and potentially discontin
Thyroid storm is a life-threatening syndrome that results from an acute exacerbation of thyrotoxicosis. Prevention, prompt recognition, and appropriate intervention as discussed herein are key to the prevention of death and morbidity in affected patients. I hope you find it educating as well as enlightening.
This document discusses sepsis and septic shock and provides guidelines for management. It defines sepsis as a systemic inflammatory response to infection and outlines the sepsis spectrum from sepsis to septic shock. It describes the typical host immune response and how an uncontrolled response can lead to systemic effects. Clinical presentation, diagnosis, bacteriology, and management including initial resuscitation, antimicrobial therapy and treatment duration are covered. Treatment aims to rapidly identify and treat the infection while stabilizing the patient and preventing further progression along the sepsis spectrum.
Serum magnesium level in children with bronchial asthma Azad Haleem
- The study aimed to determine the prevalence of hypomagnesemia (low magnesium levels) among asthmatic children compared to healthy controls.
- The mean serum magnesium level was found to be significantly lower in asthmatic children (1.91 mg/dL) than in healthy controls (2.03 mg/dL).
- Within the asthmatic group, serum magnesium levels decreased with increased asthma severity and inversely correlated with duration of asthma, though not significantly.
- The study concluded that asthmatic children have higher risk of magnesium deficiency and supplementation may help improve asthma outcomes.
This document summarizes the current state of anemia treatment in chronic kidney disease (CKD) patients. It discusses the magnitude of the problem, clinical management including use of erythropoiesis-stimulating agents (ESAs), and future therapies. ESAs are currently the mainstay of treatment but have limitations like requiring high doses and increased risks at higher hemoglobin levels. Newer approaches being researched include stabilizing hypoxia-inducible factor to stimulate endogenous erythropoietin production, modulating the iron-regulating hormone hepcidin, and gene therapy to introduce the erythropoietin gene directly.
The document discusses the importance of preoperative evaluation and optimization of patient health before surgery. The key purposes are to document medical conditions requiring surgery, assess overall health status, uncover hidden conditions that could cause problems during or after surgery, determine perioperative risk, and develop an appropriate perioperative care plan. This involves a thorough medical history, physical exam, and laboratory tests to evaluate organ function and minimize surgical risks. The goal is to reduce postoperative complications and facilitate a quick recovery.
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This document outlines critical care nutrition and metabolic response to stress and injury. It discusses how critical illness leads to catabolism and increased nutritional needs. Early enteral nutrition is preferred over total parenteral nutrition when possible due to lower risks of infection. Glutamine supplementation, especially at higher intravenous doses, may reduce mortality, infections, and length of stay in critically ill patients.
This document discusses the evolution of treatments for acute ischemic stroke caused by large vessel occlusion over the past three decades. It describes the development of intravenous thrombolysis using alteplase, including early safety trials, phase 3 efficacy trials, and limitations. It also discusses the emergence of endovascular therapies such as mechanical thrombectomy and the importance of neuroimaging such as CT and CT perfusion in selecting appropriate patients. The role of collateral circulation and a "tissue window" approach are also highlighted.
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Polymyositis as an Extra-Intestinal Manifestation of Ulcerative Colitis in a ...merdaci dhia elhak
A 28-year-old woman with a history of ulcerative colitis presented with muscle weakness, myalgias, and constitutional symptoms. Tests found elevated muscle enzymes and inflammation on muscle biopsy. She was diagnosed with polymyositis, a rare extra-intestinal manifestation of ulcerative colitis. Treatment with steroids and azathioprine improved her symptoms. While disease activity is not required, extra-intestinal manifestations like polymyositis should be considered in ulcerative colitis patients with muscle symptoms. Both conditions responded well to immunosuppressive therapy.
This patient presented with multiple symptoms including loose motions, blisters, cough, shortness of breath, abdominal fullness, and limb swelling. Laboratory tests found hypothyroidism, hypokalemia, anemia, and leukocytosis. Sputum culture grew Klebsiella pneumoniae and Acinetobacter species. The patient was diagnosed with Addison's disease, hypothyroidism, acute gastroenteritis caused by Giardia, iatrogenic Cushing's syndrome and pneumonia. The patient has a history of taking hydrocortisone, fludrocortisone, thyroxine, and prednisone for Addison's disease and hypothyroidism treatment, but developed Cushing's
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Nephritis is a inflammation of kidney .
It is classified into various types like lupus nephritis ,interstitial nephritis , glomerulonephritis ,pyelonephritis.
Lupus nephritis is an inflammation of kidney due to autoimmune disorder named as lupus .
It is inflammation of lower urinary tract .
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Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
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1. Title
• Prediction of the grade of acute cholecystitis
by plasma level of c-reactive protein
2. Authors
• Esin Kabul Gurbulak Department Of General Surgery ,Sisli Hamidiye Etfal Training And
Research Hospital,istanbul,turkey
• Bunyamin Gurbulak Department Of General Surgery ,Arnavutkoy State
Hospital,istanbul,turkey
• Ismail Ethem Akgun Department Of General Surgery, Sisli Hamidiye Etfal Training And
Research Hospital,Istanbul,turkey
• Yigit Duzkoylu Department Of General Surgery,Istanbul Training And Research Hospital,
Istanbul,turkey
• Muharrem Battal Department Of General Surgery ,Sisli Hamidiye Etfal Training And Research
Hospital,istanbul,turkey
• MUSTAFA FEVI CELAYIRDepartment Of General Surgery ,Sisli Hamidiye Etfal Training And
Research Hospital,istanbul,turkey
• UYGAR DEMIR Department Of General Surgery ,Sisli Hamidiye Etfal Training And Research
Hospital,istanbul,turkey
3. Source
• Iran Red Crescent Med J. 2015 April; 17(4):
e28091
• Paper Accepted: March 24, 2015
• Paper Published :April 25,2015
4. Abstract
• Background
• Acute cholecystitis is the most common
complication of gallbladder stones. Today,
Tokyo guidelines criteria are recommended for
diagnosis, grading, and management of acute
cholecystitis .
5. Objectives
• We aimed to evaluate the levels of C-reactive
protein (CRP) at different cut-off values to
predict the severity of the disease and its
possible role in grading the disease with
regard to the guideline.
6. Methods
• This is a retrospective study, analyzing 682 cases out of
consecutive 892 patients with acute cholecystitis admitted
to two different general surgery clinics in Istanbul, Turkey.
Records of patients diagnosed with acute cholecystitis were
screened retrospectively from the hospital computer
database between January 2011 and July 2014. A total of
210 patients with concomitant diseases causing high CRP
levels were excluded from the study. The criteria of Tokyo
guidelines were used in grading the severity of acute
cholecystitis, and patients were divided into 3 groups. CRP
values at the time of admission were analyzed and
compared among the groups.
7. Result
Mean CRP levels of groups were found to be significantly different, 18.96
mg/L in Group I, 133.51 mg/L in Group II, and 237.23 mg/L in Group III (P <
0.001). Having examined CRP values among the groups, they were found
Group III (P < 0.001). Having examined CRP values among the groups, they
were found to be highly and significantly correlated with the disease grade (P
< 0.0001). After evaluating CRP levels according to the grade of the disease,
group 2 was distinguished from group 1 with a cut-off CRP level of 70.65
mg/L, and from group 3 with a value of 198.95 mg/L. Those results were
found to be statistically significant (P < 0.001).
8. Conclusion
• CRP, a well-known acute phase reactant that
increases rapidly in various inflammatory
processes, can be accepted as a strong
predictor in classifying different grades of the
disease, and treatment can be reliably
planned according to this classification.
9. Tokyo guidelines for acute cholecystitis
Grade 1 Mild
• Acute cholecystitis not meeting other severity
criteria.
• Mild gallbladder inflammation, no organ
dysfunction.
10. Grade 2 Moderate
• Acute cholecystitis with any of following
conditions:
• Elevated WBC count (> 18000/mL)
• Palpable tender mass at right upper quadrant
• Duration of complaints > 72 h Marked local inflammation, such as biliary
peritonitis, pericholecystic abscess, hepatic abscess, gangrenous cholecystitis,
emphysematous cholecystitis
11. Grade 3 severe
• Acute cholecystitis is associated with
dysfunction of any one of the following
organs/systems
• Cardiovascular dysfunction (hypotension requiring treatment with dopamine
> 5 mg/kg/min (body weight) or any dose of norepinephrine)
• Neurological dysfunction (decreased level of conscious- ness)
• Respiratory dysfunction (PaO2/FiO2 < 300)
• Renal dysfunction (oliguria, creatinine > 2.0 mg/dL)
• Hepatic dysfunction (PT-INR > 1.5)
• Hematologic dysfunction (platelet count < 100000/mL)
12. References
1. Strasberg SM. Clinical practice. Acute calculous cholecystitis. N Engl J Med.
2008;358(26):2804–11.
2.Okamoto K, Takada T, Strasberg SM, Solomkin JS, Pitt HA, Garden OJ, et al.
TG13 management bundles for acute cholangitis and
3. Mayumi T, Someya K, Ootubo H, Takama T, Kido T, Kamezaki F, et al.
Progression of Tokyo Guidelines and Japanese Guidelines for management of
acute cholangitis and cholecystitis. J UOEH. 2013;35(4):249–57.
4. Hirota M, Takada T, Kawarada Y, Nimura Y, Miura F, Hirata K, et al.
Diagnostic criteria and severity assessment of acute cholecysti- tis: Tokyo
Guidelines. J Hepatobiliary Pancreat Surg. 2007;14(1):78– 82.
5. Yokoe M, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Gomi H, et al.
New diagnostic criteria and severity assessment of acute cholecystitis in
revised Tokyo Guidelines. J Hepatobiliary Pancreat Sci. 2012;19(5):578–85.
6. Vigushin DM, Pepys MB, Hawkins PN. Metabolic and scintigraph- ic studies
of radioiodinated human C-reactive protein in health and disease. J Clin
Invest. 1993;91(4):1351–7.
