Table 1 Diagnostic criteria and severity grading of acute cholecystitis as proposed in the TK 07/13 guidelines [1, 2]

Diagnostic criteria

 - Local signs of inflammation: Murphy’s sign, pain/tenderness/mass in RUQ

 - Systemic signs of inflammation: fever, elevated CRP and WBC

 - Imaging : Ultrasound, CT, MRI

Severity grading

 Grade I: mild acute cholecystitis

  - Acute cholecystitis in an otherwise healthy patient

  - ^amild inflammatory changes of the gallbladder, e.g., edematous cholecystitis

 Grade II: moderate acute cholecystitis

  - Clinical symptoms > 72 h

  - Palpable mass in the RUQ

  - Positive Murphy’s sign

  - WBC > 18.000 /ul

  - ^amarked gallbladder inflammation e.g., gangrenous cholecystitis

 Grade III: severe acute cholecystitis

  - Acute cholecystitis with at least one of the following organ dysfunction

  - Cardiovascular: hypotension requiring catecholamine

  - ^aSevere gallbladder inflammation e.g., necrotizing cholecystitis