title: Enzyme pattern of biliary colic: A counterintuitive picture.
abstract: OBJECTIVE
  To evaluate the diagnostic value of serial biochemical blood tests in the diagnosis of biliary colic.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Serial serum liver enzyme measurements are helpful in the initial diagnosis of acute biliary colic.
authors.affiliation: Elad Resnick, Department of Interns, Hadassah University Hospital, Kiryat Hadassah, Jerusalem 91120, Israel.
authors.forename: Elad
authors.initials: E
authors.lastname: Resnick
authors.affiliation: Elad Resnick, Department of Interns, Hadassah University Hospital, Kiryat Hadassah, Jerusalem 91120, Israel.
authors.forename: Shimon
authors.initials: S
authors.lastname: Shteingart
authors.affiliation: Elad Resnick, Department of Interns, Hadassah University Hospital, Kiryat Hadassah, Jerusalem 91120, Israel.
authors.forename: Bernardo
authors.initials: B
authors.lastname: Melamud
authors.affiliation: Elad Resnick, Department of Interns, Hadassah University Hospital, Kiryat Hadassah, Jerusalem 91120, Israel.
authors.forename: Tali
authors.initials: T
authors.lastname: Bdolah-Abram
authors.affiliation: Elad Resnick, Department of Interns, Hadassah University Hospital, Kiryat Hadassah, Jerusalem 91120, Israel.
authors.forename: Todd
authors.initials: T
authors.lastname: Zalut
authors.affiliation: Elad Resnick, Department of Interns, Hadassah University Hospital, Kiryat Hadassah, Jerusalem 91120, Israel.
authors.forename: Adrian
authors.initials: A
authors.lastname: Reuben
authors.affiliation: Elad Resnick, Department of Interns, Hadassah University Hospital, Kiryat Hadassah, Jerusalem 91120, Israel.
authors.forename: Yoav
authors.initials: Y
authors.lastname: Lurie
keywords: Alanine aminotransferase; Aspartate aminotransferase; Biliary colic; Diagnostic tool; Emergency department; Enzyme pattern; Gallstones; Liver enzymes; Symptomatic cholelithiasis