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

Abstract

Background Acute common bile duct (CBD) obstruction due to calculi leads to intra ductal hypertension and transient hepato-cellular injury. Fatty liver disease (FLD) has adverse impact on hepatic microcirculation. This study compares liver enzymes, inflammatory markers and bilirubin levels in patients with and without fatty liver disease (FLD) presenting with common bile duct (CBD) obstruction. Methods CBD colic was diagnosed based on clinical, radiological and biochemical criterion. Patients were divided in to two groups as presence or absence of FLD based on ultra sound scan and the macroscopic appearance of liver during surgery. AST, ALT, bilirubin level and inflammatory markers were prospectively assessed and the peak levels were compared between the two groups. Results Out of 42 individuals, there were 22 (52.3%) patients with FLD. Median body mass index was 26.9 (24.1 – 30.8) in fatty liver group compared to 25.7 (23.5 – 26.2) in others. Individuals with FLD showed high AST (558.5 vs. 247.0, p = 0.005), ALT (467 vs. 228.5, p = 0.005) and bilirubin (3.8 vs. 2.2, p = 0.015) levels compared to those without FLD. According to multiple linear regression models, high AST and ALT levels showed significant associations with FLD after adjusting for age, gender, BMI, amylase and CRP levels. The median enzyme level at two weeks did not show a difference. Conclusions Presence of FLD causes unusual rise of AST and ALT levels in patients with CBD stones. This rise is transient.