title: A New Paradigm in Gallstones Diseases and Marked Elevation of Transaminases: An Observational Study.
abstract: In clinical practice, it is assumed that a severe rise in transaminases is caused by ischemic, viral or toxic hepatitis. Nevertheless, cases of biliary obstruction have increasingly been associated with significant hypertransaminemia. With this study, we sought to determine the true etiology of marked rise in transaminases levels, in the context of an emergency department.
  
  
  
  We retrospectively identified all patients admitted to the emergency unit at Centro Hospitalar e Universitário de Coimbra between 1st January 2010 and 31st December 2010, displaying an increase of at least one of the transaminases by more than 15 times. All patient records were analyzed in order to determine the cause of hypertransaminemia.
  
  
  
  We analyzed 273 patients - 146 males, mean age 65.1 ± 19.4 years. The most frequently etiology found for marked hypertransaminemia was pancreaticobiliary acute disease (n = 142;39.4%), mostly lithiasic (n = 113;79.6%), followed by malignancy (n = 74;20.6%), ischemic hepatitis (n = 61;17.0%), acute primary hepatocellular disease (n = 50;13.9%) and muscle damage (n = 23;6.4%). We were not able to determine a diagnosis for 10 cases. There were 27 cases of recurrence in the lithiasic pancreaticobiliary pathology group. Recurrence was more frequent in the group of patients who had not been submitted to early cholecystectomy after the first episode of biliary obstruction (p = 0.014). The etiology of hypertransaminemia varied according to age, cholestasis and glutamic-pyruvic transaminase values.
  
  
  
  Pancreaticobiliary lithiasis is the main cause of marked hypertransaminemia. Hence, it must be considered when dealing with such situations. Not performing cholecystectomy early on, after the first episode of biliary obstruction, may lead to recurrence.
authors.affiliation: Gastroenterology department, Centro Hospitalar e Universitário de Coimbra (CHUC).
authors.forename: Sara
authors.initials: S
authors.lastname: Campos
authors.affiliation: Internal Medicine department, Centro Hospitalar e Universitário de Coimbra.
authors.forename: Nuno
authors.initials: N
authors.lastname: Silva
authors.affiliation: Internal Medicine department, Centro Hospitalar e Universitário de Coimbra (CHUC).
authors.forename: Armando
authors.initials: A
authors.lastname: Carvalho
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000097:blood*; D001219:Aspartate Aminotransferases / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002763:Cholecystectomy; D004636:Emergency Service, Hospital; D005260:Female; D042882:Gallstones / Q000097:blood* / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D011174:Portugal; D011237:Predictive Value of Tests; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase
keywords: Ischemic hepatitis; Transaminases.; biliary obstruction; toxic hepatitis; viral hepatitis