Contrasting liver function test patterns in obstructive jaundice due to biliary structures and stones

Abstract

The conventional wisdom that ALP rises more than AST in obstructive jaundice holds true where the jaundice is due to strictures, but in obstructive stone disease, the rise in AST may equal that in ALP, or even exceed it during maximum jaundice and during painful episodes. Clinicians should consider the possibility of extrahepatic biliary obstruction, even when AST is the predominantly elevated enzyme.

Enzyme pattern of biliary colic: A counterintuitive picture

“…We and others[11-13] have also observed another distinct pattern of a sharp (up to 100-fold above the upper limit of the normal reference range), short-lived (usually less than a week) rise in AST and ALT, and only a mild rise in ALKP, bilirubin and GGT, which we think is characteristic of acute “biliary colic”. Our clinical impression is that this pattern has high specificity for the diagnosis of “biliary colic” especially in the first hours of the patient’s admission, which is paradoxically counterintuitive in a patient, who has “surgical” pain with a “medical” enzyme pattern.…”

Transient Arterial Enhancement of the Hepatic Parenchyma in Patients With Acute Cholangitis

“…Cholestatic disease including cholangitis causes worsening of the liver biochemistry, and especially an elevation of ALP and AST levels. 19,20 Among these laboratory findings, a correlative trend was more prominent between the grade of TAE and WBC count (r = 0.540, P G 0.001), and between the grade of TAE and the CRP concentration (r = 0.514, P G 0.001). These results suggest that TAE on a dynamic CT scan may have a certain degree of association with the cholestatic clinical situation but is more highly associated with an inflammatory process.…”

Diagnosing Biliary Malignancy

“…Direct hyperbilirubinemia is seen more commonly in Xu & Sethi patients with malignant obstruction than in those with a benign cause such as choledocholithiasis. 8 Hyperbilirubinemia also has a higher likelihood of being associated with malignancy than increases in alkaline phosphatase level. 9,10 Serum CA 19-9 (carbohydrate antigen has been reported to have a sensitivity of 70% to 80% in the diagnosis of malignant strictures, with a specificity of 80% to 90%.…”