A Study on Clinical Characteristics of Acute Cholecystitis and Its Relation With Elevated Liver Enzymes and Bilirubin

Abstract

ntroduction: Acute cholecystitis is the most common complication in a gallstone disease and remains one of the most common medical problems leading to surgical intervention. The clinical picture of the patients with acute cholecystitis is further complicated by deranged liver function tests due to inammatory process induced by cholecystitis.74Liver damage in patients with gallstones is thought to be the result of chronic extra hepatic biliary tract obstruction with or without repeated episodes of cholangitis.69However, a few studies have reported the presence of hepatocellular injury in patients with acute cholecystitis without choledocholithiasis.70,38We conducted this study further to demonstrate any relation of gallstones with deranged liver function. This tertiary clinic based prospective observational study on 100 patients of gallMethods: stone disease diagnosed on imaging, was conducted at the Department of Surgery, Silchar Medical College and Hospital from 7th June 2018 to 6th June 2019.All routine tests with special reference to Total Leucocyte and Differential Leucocyte counts and Liver function tests- with special reference to serum bilirubin and fraction, Serum AST, ALT, ALP,GGT were obtained and statistical analysis performed to demonstrate their inter- relationship with gallstone disease. On the day of admission (day-0), 32 patients (15.62% male & 84.37% female) had increased level ofResult: AST. Similarly, ALT was increased in 49 patients (20.4% male & 79.59% female), ALP was increased in 32 patients (15.62% male & 84.37% female), GGT was increased in 38 patients (26.31% male & 73.6% female).All four liver enzymes were increased in 32% patients (12.5% male & 87.5% female). Total Bilirubin was increased in 17 patients out of which 35.29% were Male and 64.7% were Female. Direct Bilirubin was increased in 26% patients (9 Males and 17 Females). Total Leucocytic count was increased in 60 patients out of which 14(23.3%) were Males and 46(76.6%) were Females. On the day of admission, AST was found to be in the range of 19U/L- 116U/L in the study population with a mean value of 48.10+27.59 and median value of 37.50.ALT was found to be in the range of 3U/L-141U/L in the study population with a mean value of 56.33+33.75 and median value of 40. ALP was found to be in the range of 60U/L-234U/L in the study population with a mean value of 117.58+39.64 and median value of 100.50. GGT was found to be in the range of 22U/L- 154U/L in the study population with a mean value of 74.66+30.05 and median value of 69.50. The mean values of Liver enzymes, Bilirubin (Total & Direct) and TLC were found to be signicantly decreased on 6 weeks after admission. Liver enzymes and bilirubin tend to marginally increase in few cases of acute cholecystitis asConclusion: a result of the inammatory process. However, this increase is transient and the levels come down to normal once the inammatory process of acute cholecystitis subsides.