Enzyme pattern of biliary colic: A counterintuitive picture

Abstract

AIMTo evaluate the diagnostic value of serial biochemical blood tests in the diagnosis of biliary colic.METHODSFiles were reviewed of 1039 patients who were admitted to the Share’e Zedek Medical Center emergency department between the years 2012-2013, and received the coding of acute biliary disease. Of these, the first 100 cases were selected that met the following criteria: (1) a diagnosis of biliary colic or symptomatic cholelithiasis; (2) at least two biochemical blood tests performed; and (3) 18 years of age or older. Patients with other acute biliary diseases were excluded. The biochemical profile of the patients was analyzed as were their clinical and radiological findings.RESULTSThree-quarters of the patients were women, whose average age of 37 years was younger than the average of the men, at 50 years. According to their histories, 47% of the patients had previously known cholelithiasis. Pain in either the right upper quadrant or the epigastrium was the presenting symptom in 93% cases. The greatest change in serum biochemical results was seen during the first day of the patients’ admissions. Alanine aminotransferase (ALT) showed the highest initial rise above the reference range, followed by aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), bilirubin and alkaline phosphatase (ALKP) - all these increases were statistically significant (P < 0.05). AST showed the sharpest decline followed by bilirubin and ALT. GGT and ALKP did not fall. A sharp rise and fall in liver enzymes, especially during the first day, most prominently in AST and ALT, was seen in 70% percent of cases. In 65% of cases trans-abdominal sonography did not give diagnostic findings.CONCLUSIONSerial serum liver enzyme measurements are helpful in the initial diagnosis of acute biliary colic.

Title: Presence of fatty liver disease leads to unusual rise of liver enzymes in patients with common bile duct colic.

“…Gallstones obstructing the common bile duct lead to intra ductal hypertension. Gamma glutamyl transferase and alkaline phosphatase are classically considered to rise in obstructive causes [7,8]. Rise in AST and ALT is probably a result of high biliary pressures leading to impairment of bile secretion and retention with accompanying hepatocyte apoptosis and necrosis leading to leakage of enzymes [1].…”

Win or lose, nighttime transcystic laparoscopic common bile duct exploration is a win

“…While not reaching statistical significance, this analysis is limited by the few numbers of failed LC+LCBDE. The ‘OR first’ model, which provides a primary attempt at duct clearance, avoids any delays that might arise from practice patterns of trending liver function tests (LFTs) or obtaining magnetic resonance cholangiopancreatography (MRCP) imaging prior to ERCP that often occur when these patients 23 24. Further, developing predictors of failed LCBDE during LC may help identify patients in which early gastroenterology involvement for possible ERCP could further reduce LOS and hospital costs.…”

Gallstone Hepatitis Caused by Transient Common Bile Duct Obstruction in a Middle-Aged Woman

“…The course of the current case was similar, and it was difficult to distinguish gallstone hepatitis from acute hepatitis using biochemical tests alone. Furthermore, ALP levels have been reported to increase later than AST and ALT levels, while GGT levels after peak decline more slowly than AST and ALT levels [ 8 ]. In the present case, ALP and GGT levels increased later than AST and ALT levels.…”