[Macroscopic liver pathology in patients with dissociated cholestasis].
OBJECTIVE
To establish the prevalence of liver focal pathology in patients with increase of alkaline phosphatase and gamma-glutamil transpeptidase and normal bilirubin (dissociated cholestasis), and to analyze the related risk factors for such pathology.


METHODS
All laboratory studies of patients admitted to an Internal Medicine Department were reviewed prospectively throughout a period of 9 months. For the purpose of detecting focal liver pathology imaging liver studies (echography and/or CT) were carried out in those in which biochemical analyses showed dissociated cholestasis.


RESULTS
A dissociated cholestasis pattern was found in 81 patients. In 13 of them (16%) focal liver pathology was demonstrated. The majority of the lesions (10 of 13) were local or metastatic malignant neoplasms. Sex, alcohol consumption, presence of diabetes mellitus, tumor or hepatobiliar disease previously known, or abnormalities in liver physical examination were not risk factors. No liver pathology was found in patients with an alkaline phosphatase level higher than double of gamma-glutamil transpeptidase level (sensitivity: 100%; negative predictive value: 100%). Diagnosis of a non-hepatic malignant neoplasm at discharge was associated to a risk 12 times bigger for the presence of liver lesions (p < 0.01).


CONCLUSIONS
It is uncommon to find focal liver pathology in patients with dissociated cholestasis. It is more common to discover focal liver pathology in patients with non-hepatic tumors and less probable when phosphatase alcaline: gamma-glutamil transpeptidase ratio is higher than two.
Polo Sabau
J L
JL
Departamento de Medicina Interna, Fundación Jiménez Díaz, Madrid. polosabau@yahoo.com
García Lorenzo
M D
MD
Molina Robles
M
M
Carrión Román
G
G
San Miguel Tabernero
B
B
Franco López
A
A
Braun Saro
B
B
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000469:Alkaline Phosphatase / Q000097:blood; D001663:Bilirubin / Q000097:blood; D002779:Cholestasis / Q000097:blood / Q000209:etiology*; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D005723:gamma-Glutamyltransferase / Q000097:blood
D005723:gamma-Glutamyltransferase; D000469:Alkaline Phosphatase; D001663:Bilirubin