title: Duration of pain is correlated with elevation in liver function tests in patients with symptomatic choledocholithiasis.
abstract: OBJECTIVE
  We assessed the temporal relationship between abdominal pain and elevation in liver function tests (LFTs) in patients with acute symptomatic choledocholithiasis.
  
  
  METHODS
  Retrospective study of patients that presented within 12 hours of pain onset and were subsequently found to have choledocholithiasis.
  
  
  RESULTS
  We identified 40 patients with complete medical records. Levels of aspartate and alanine aminotransferases (AST and ALT) correlated with duration of pain (Pearson correlation, r = 0.633 and 0.622 respectively, P < .001 for both); the correlation was not as strong for γ-glutamyl transpeptidase (GGT) (r = 0.326, P = .046) and was not significant for alkaline phosphatase or bilirubin. This temporal association was stronger in patients that had undergone cholecystectomy versus those with intact gallbladders (for ALT, r = 0.603 vs r = 0.311, respectively). Eighteen patients, evaluated within 6 hours of pain, had normal or minimal alterations in LFTs; transabdominal ultrasound was abnormal in 6 (sensitivity 33.3%). All had repeat LFTs within 24 hours (mean 10.3 ± 6.9 hours later) and large increases in ALT and aspartate aminotransferase levels (mean 10.5- and 6.8-fold respectively; P < .01 for both), intermediate increases in glutamyl transpeptidase levels, (mean 4-fold, P < .05), and no changes in alkaline phosphatase levels. This significant increase in LFTs was the only indication of biliary pathology before endoscopy in 11/18 patients.
  
  
  CONCLUSIONS
  Increasing duration of pain is associated with increasing LFTs (particularly transaminases) in patients with acute symptomatic choledocholithiasis. Patients with normal LFTs and ultrasound upon presentation should have repeat LFTs if biliary pain is suspected. The absence of significant biochemical abnormalities within the first 24 hours makes the diagnosis of symptomatic choledocholithiasis unlikely.
authors.affiliation: Department of Internal Medicine, American University of Beirut Medical Center, Lebanon. as08@aub.edu.lb
authors.forename: Ala I
authors.initials: AI
authors.lastname: Sharara
authors.forename: Nabil M
authors.initials: NM
authors.lastname: Mansour
authors.forename: Mustafa
authors.initials: M
authors.lastname: El-Hakam
authors.forename: Ola
authors.initials: O
authors.lastname: Ghaith
authors.forename: Mustapha
authors.initials: M
authors.lastname: El Halabi
mesh_terms: D015746:Abdominal Pain / Q000150:complications*; D000328:Adult; D000368:Aged; D042883:Choledocholithiasis / Q000150:complications* / Q000473:pathology*; D004798:Enzymes / Q000097:blood*; D005260:Female; D006801:Humans; D008099:Liver / Q000201:enzymology*; D008107:Liver Diseases / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D004798:Enzymes