Biliary event | Definition |
---|---|
Biliary pancreatitis | Diagnosis of acute pancreatitis if at least two of the three following features are present [19]: |
1. Upper abdominal pain; | |
2. Serum lipase or amylase levels above three times the upper level of normal; | |
3. Characteristic findings of acute pancreatitis on cross-sectional abdominal imaging. | |
Biliary pancreatitis if one of the following definitions is present [20]: | |
1. Gallstones and/or sludge diagnosed on imaging (transabdominal or endoscopic ultrasound or computed tomography); | |
2. In the absence of gallstones and/or sludge, a dilated common bile duct on ultrasound (>8 mm in patients ≤75 years old or >10 mm in patients >75 years old); | |
 | 3. The following laboratory abnormality: alanine aminotransferase (ALAT) level >2 times higher than normal values, with ALAT >aspartate aminotransferase. |
Acute cholecystitis | Defined according to the 2007 Tokyo classification, grade I to III [21, 22]. |
A. Local signs of inflammation: | |
1) Murphy’s sign; | |
2) RUQ mass/pain/tenderness. | |
B. Systemic signs of inflammation: | |
1) Fever; | |
2) Elevated C-reactive protein; | |
3) Elevated white blood cell count. | |
C. Imaging findings characteristic of acute cholecystitis | |
Definite diagnosis | |
1) One item in A and one item in B are positive; | |
 | 2) C confirms the diagnosis when acute cholecystitis is suspected clinically. |
Biliary colic | Upper abdominal pain (either right upper quadrant or epigastric pain) lasting at least 30 minutes, according to the Rome criteria [22]. |