Published online Dec 28, 2016. doi: 10.4254/wjh.v8.i36.1629
Peer-review started: July 1, 2016
First decision: September 5, 2016
Revised: October 2, 2016
Accepted: November 1, 2016
Article in press: November 2, 2016
Published online: December 28, 2016
To evaluate the diagnostic value of serial biochemical blood tests in the diagnosis of biliary colic.
Files 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.
Three-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.
Serial serum liver enzyme measurements are helpful in the initial diagnosis of acute biliary colic.
Core tip: Gallstones are prevalent in affluent countries, more so in women than in men, and their prevalence increases with age. A large proportion of patients presenting to the emergency department with epigastric or right upper quadrant (RUQ) pain present a diagnostic challenge, especially when they belong to the older age group. We found that serial liver and biliary enzyme measurements reveal a characteristic pattern that helps the clinician determine quickly, cheaply and safely that the cause of RUQ/epigastric pain is biliary colic, in 71% of the patients. Serial enzyme testing is a useful adjunct to other diagnostic tools, for the diagnosis of acute upper abdominal pain.