High Serum Transaminase Activity Associated With Extrahepatic Biliary Disease

Serum Transaminase Levels and Cholescintigraphic Abnormalities in Acute Biliary Tract Obstruction

“…The white blood cell (WBC) count was greater than 10.0 x 107L (10 000/mm3) in 15 patients. Six patients whose WBC count was less than 10.0xl09/L (10 000/mm3) had evidence of a left shift and band forms, while four patients had normal WBC counts.…”

Myocardial Infarction-like Syndrome in Cholecystectomized Patients Given Narcotics

“…Elevation of S.G.O.T. activity following narcotic administration occurs only in an individual with cholecystectomy or nonfunctioning gall-bladder (Mossberg et al, 1962). The mechanism is probably similar to narcotic-induced elevation of amylase activity.…”

“…activity in excess of 300 units in relation to uncomplicated extrahepatic biliary obstruction has been documented (Mossberg and Ross, 1963). Particularly interesting was the case of a 54-year-old white man (Mossberg and Ross, 1963) admitted because of substernal pain, a high transaminase level, and electrocardiographic changes suggesting acute coronary ischaemia. He was treated with the usual coronary regimen, and his hospital course was complicated by several transaminase spikes attributed to "extension of the infarct."…”

“…Although hyperamylasaemia can follow narcotic administration in normal individuals (Bogoch, Roth, and Bockus, 1954), a narcotic-induced rise of serum glutamic oxaloacetic transaminase (S.G.O.T.) activity occurs chiefly in patients with cholecystectomy or non-functioning gall-bladder (Mossberg, Bloom, Berkowitz, and Ross, 1962) Electrocardiographic changes, too, can result from increased intrabiliary pressure (Clarke, 1945).…”

Choledocholithiasis presenting with very high transaminase level

“…Transaminase elevations are more pronounced after morphine injection and extrahepatic biliary obstruction in animals post-cholecystectomy compared with controls 11 12 and it has been proposed that the gallbladder acts as a reservoir for sudden increases in pressure following ductal obstruction 7. Older theories proposed by Mossberg and Ross included regurgitation of transaminases from biliary canaliculi into the bloodstream and increased enzyme production from damaged liver cells 13. More recent research suggests that bile salt-induced hepatocyte necrosis is a consequence of mitochondrial dysfunction,14 resulting in depleted ATP levels and sustained influx of Ca 2+ leading to hepatocyte necrosis 15…”