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