Can Increased Liver Enzymes Be A Symptom Of Cholecystitis?

In uncomplicated acute cholecystitis, liver tests are usually normal or slightly elevated, with mild cholestatic abnormalities such as bilirubin up to 4 mg/dL and mildly elevated alkaline phosphatase. Elevated liver enzymes are observed occasionally in patients with acute cholecystitis who do not have choledocholithiasis. Abnormal liver function tests are strong predictors for the presence of CBD stone in patients with acute cholecystitis, with ALP being stronger than SGOT. Hepatocellular injury is uncommon with cholecystitis alone. Gallstones can also cause elevation of liver enzymes or hepatomegaly and are detected on testing while the patient is completely asymptomatic. Chronic cholecystitis is not known to cause high elevations of liver enzymes or cause fulminant liver failure. This study found an increase in the activities of the biochemical indicators of liver enzymes: ALT, AST, ALP, GGT, and total bilirubin. An increased number of white blood cells (leukocytosis) with a left shift is also observed.

Can a gallstone cause elevated liver enzymes in pancreatitis?

Purpose: Biliary etiology for the acute pancreatitis(AP) is suspected when patients meet one or both of the following criteria: A) elevated liver enzymes ( 3X increase of alanine aminotransferase (ALT) or aspartate aminotransferase (AST) on day 1 of AP, or B) presence of gallstones/sludge on abdominal ultrasound. To prevent recurrence of acute biliary pancreatitis, current recommendations are to perform cholecystectomy after the first episode of gallstone pancreatitis. However, cholecystectomy is also recommended for 2 or more attacks of idiopathic pancreatitis with the hope of preventing recurrence. In a population-based study, we examined recurrence rates after cholecystectomy for AP.

Methods: We retrospectively abstracted data of all Olmsted County residents who were diagnosed with AP at Mayo Clinic ( 90% of all patients) between 1990 and 2005 (n=1049). We classified patients with AP into groups I-IV based on the presence or absence of criteria A and B noted above: I) A+B, II) only A, III) only B and IV) neither A nor B. We identified 239 patients who underwent a cholecystectomy as treatment of AP and determined recurrence rates of AP in patient groups I-IV before and after excluding known etiologies for recurrence (retained or re-formed bile duct stones, elevated serum calcium/triglycerides, etc).

Results: After a median follow-up after cholecystectomy of 99 months (range 8-220), AP recurred in 41/239 (17%) patients (Table). However, in 18/41 (44%) patients with recurrence, another etiology could be identified (CBD stone/s in 13, hypertriglyceridemia 1, others 4). Over 60% of recurrences in Group I could be attributed to retained common bile duct stones (n=6) or stenosis (n=3) at the site of previous sphincterotomy.

Can cholecystitis cause liver problems?

What are the complications of cholecystitis?. In some cases cholecystitis can cause other problems including:

• Infection and pus buildup in your gallbladder
• Tissue death in your gallbladder (gangrene)
• Bile duct injury that can affect your liver
• Infection and inflammation of your pancreas (pancreatitis)
• Infection and inflammation of the lining of your belly (peritonitis)

If your gallbladder has not been removed and you have more attacks of cholecystitis, you may develop long-term (chronic) cholecystitis.

Chronic cholecystitis may not cause any symptoms. But it can damage the walls of your gallbladder. The walls can become scarred and get thicker. Your gallbladder will start to get smaller. Over time, it will be less able to store and release bile. You will need surgery to remove your gallbladder.

Can gallbladder removal cause high AST and ALT levels?

The study investigated the incidence of increased aspartate aminotransferase (AST), alanine aminotransferase (ALT), and bilirubin levels after laparoscopic cholecystectomy. The study involved 67 patients with normal preoperative liver function tests and blood samples 24 hours after the procedure. The results showed a mean 1. 8-fold increase in AST in 73 patients, a 2. 2-fold increase in ALT in 82 patients, a statistically nonsignificant increase in 53 patients (ALP remained within normal limits), and increased bilirubin levels in 14 patients (primarily of the unconjugated type). The cause of this increase is unclear, and these elevations appear to have no clinical significance. The cause of this is unclear, and these elevations appear to have no clinical significance. The study concluded that in many patients, a significant increase in AST and ALT levels occurred after laparoscopic cholecystectomy, but they returned to normal values within 72 hours.

Which liver enzymes are elevated in cholecystitis?

Severe elevations in liver transaminases, such as AST/ALT greater than 15 times normal, are common in drug-induced hepatitis, ischemic hepatitis, autoimmune hepatitis, and acute viral hepatitis. Cholecystitis is more often associated with leukocytosis and normal liver chemistries. A young female with epigastric abdominal pain and nausea after eating was diagnosed with acute on chronic cholecystitis. She was treated with IV N-acetylcysteine for suspected drug-induced liver injury, which improved liver tests. On admission, she was found to be afebrile with a WBC count of 11. 3 k/uL, rising liver enzymes ALT 795 U/L, AST 691 U/L, total Bilirubin 1. 3 mg/dL, and a common bile duct (CBD) of 7mm. MRCP revealed a CBD of 7mm without choledocholithiasis. Her work up revealed negative viral hepatitis panel, normal ceruloplasmin, transferrin saturation of 42, normal immunoglobulin level, and positive smooth muscle antibody with low titer.

Pathology following laparoscopic cholecystectomy showed chronic cholecystitis with cholelithiasis and cholesterolosis. Severe abnormalities of liver chemistry are broad, and concurrent lab work and imaging should be employed. Cholestatic injury is typical of cholecystitis, with elevated ALT levels seen with choledocholithiasis. Hepatocellular injury is uncommon with cholecystitis alone. A retrospective review of patients with abnormal liver enzymes undergoing cholecystectomy due to acute cholecystitis showed median AST and ALT of 47 and 82. 5 U/L, respectively.

Are AST and ALT elevated in cholelithiasis?

Discussion. High levels of serum aminotransferases are used as indicators of liver parenchymal disease. AST and ALT are specific to the liver, with levels greater than 400 units/L being indicative of hepatocellular disease. Levels above 1000 units/L raise suspicion for processes that cause necrosis of hepatocellular tissue such as ischemia, viral hepatitis, or drug toxicity. 2 Markedly elevated AST levels have also been described in acute pancreatitis and pancreatic carcinoma. 3 Rarely, isolated calculous disease of the biliary tract with no hepatic disease or involvement can present with markedly elevated AST and ALT levels. It is an underrecognized phenomenon that enzymes can reach similar levels in patients with symptomatic choledocholithiasis.

Transaminase levels of about 500 units/L in both cholelithiasis and choledocholithiasis have been reported as early as 1985, with Fortson et al 3 examining 9 patients with extrahepatic biliary tract disease having liver enzymes above 600 units/L. Anciaux et al 4 found that the incidence and enzyme levels were higher in those with CBD stones, and there was decrease in enzyme levels to near-normal levels 2 to 4 weeks after cholecystectomy. One other study by Nathwani et al 2 noted hepatic chemistries elevated above 1000 units/L.

In such cases, the etiology behind remarkably elevated liver enzymes greater than 1000 units/L remains unclear. Experiments with bile duct ligation in dogs have produced AST levels in the several thousands, with higher levels seen after cholecystectomy. 2 Proposed mechanisms include elevated bile duct pressures due to the stone causing reflux of liver enzymes into hepatic sinusoids, increased production of transaminases, increased permeability of hepatocytes to release enzymes into the bloodstream, and bile acid radicals that have a direct toxic effect leading to apoptosis and eventual liver necrosis. 5, 6.

What labs are elevated with cholecystitis?

Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels are usually used to evaluate for the presence of hepatitis and may be elevated in acute cholecystitis or with common bile duct obstruction.

Bilirubin and alkaline phosphatase (ALP) assays are used to evaluate for the presence of common bile duct obstruction caused by the inflammatory edema of acute cholecystitis.

Amylase/lipase assays are usually used to evaluate for the presence of acute pancreatitis and may also be elevated mildly in acute cholecystitis.

What can cause elevated liver enzymes?

Common causes of elevated liver enzymes include:Nonprescription pain medicines, particularly acetaminophen (Tylenol, others). Certain prescription medicines, including statins, which are used to control cholesterol. Drinking alcohol. Heart failure. Hepatitis A. Hepatitis B. Hepatitis C. Nonalcoholic fatty liver disease.

How do you test for cholecystitis in the liver?

• Blood tests. Blood tests can look for signs of an infection or other gallbladder issues.
• Imaging tests that show your gallbladder. Abdominal ultrasound, endoscopic ultrasound, CT scan or magnetic resonance cholangiopancreatography can make pictures of your gallbladder and bile ducts. These pictures may show signs of cholecystitis or stones in the bile ducts and gallbladder.
• A scan that shows the movement of bile through the body. A hepatobiliary iminodiacetic acid (HIDA) scan tracks the making and flow of bile from the liver to the small intestine. A HIDA scan involves putting a radioactive dye into your body. The dye attaches to the cells that make bile. During the scan, the dye can be seen as it travels with the bile through the bile ducts. This can show any blockages.

Treatment. Treatment for cholecystitis most often involves a hospital stay to control the swelling and irritation, called inflammation, in your gallbladder. Sometimes, surgery is needed.

At the hospital, treatments to control your symptoms may include:

Can gallbladder problems cause elevated liver enzymes?

This study presents a case of a 62-year-old woman with gallstone hepatitis who had a transient elevation of liver enzyme levels due to gallstone obstruction of the biliary tract. The patient had a history of ischemic enteritis and was admitted to the hospital with abdominal pain and nausea. She had been feeling well since being discharged, but had persistent abdominal pain. Her history revealed that she drank alcohol only occasionally, did not eat oysters, deer, or wild boar, and did not consume any supplements, traditional Chinese medicines, or over-the-counter medicines. Her medical history included hypertension and hyperlipidemia. Prescribed medications included magnesium oxide, azilsartan, amlodipine besylate, rosuvastatin calcium, and betamethasone ointment. Her vital signs included body temperature, pulse rate, blood pressure, and SpO 2, 97. The patient was negative for viral acute hepatitis markers, with hepatitis B antigen level of 0. 00 IU/mL, hepatitis C virus antibody level of 0. 10 sample/cut-off (S/CO), and immunoglobulin M (IgM)-hepatitis A (HA) antibody level of 1. The patient’s hepatobiliary enzymes were monitored over time.

What is elevated in cholecystitis?

Cholecystitis is a condition characterized by a thickened gallbladder wall and gallstones, often accompanied by a high bilirubin level above 2. It can be diagnosed through a physical exam, complete blood count, and a metabolic panel. In severe cases, white blood cell count may be elevated, and liver enzymes may also be elevated. Amylase and lipase must also be checked to rule out pancreatitis. A CT scan is often ordered in the emergency department as the first imaging test, and a gallbladder ultrasound is the best test to evaluate gallbladder disease. In acute cases, a hepatobiliary (HIDA) scan is recommended to diagnose gallbladder function or cystic duct obstruction. In cases of no gallstones, acalculous cholecystitis may be diagnosed by an ejection fracture of less than 35.

The most appropriate management for cholecystitis is laparoscopic cholecystectomy, which has low morbidity and mortality rates with quick recovery. In cases where the patient is not a good laparoscopic candidate, temporizing percutaneous drainage of the gallbladder may be used. Low-fat and low-spice diets may be used in milder cases of chronic cholecystitis. Medical treatment of gallstones with ursodiol has occasionally been reported to have occasional success.

What lab results indicate acute cholecystitis?

Laboratory tests are done but are not diagnostic. Leukocytosis with a left shift is common. In uncomplicated acute cholecystitis, liver tests are normal or only slightly elevated. Mild cholestatic abnormalities (bilirubin up to 4 mg/dL and mildly elevated alkaline phosphatase) are common, probably indicating inflammatory mediators affecting the liver rather than mechanical obstruction. More marked increases, especially if lipase (amylase is less specific) is elevated 3-fold, suggest bile duct obstruction. Passage of a stone through the biliary tract increases aminotransferases (alanine, aspartate).

Ascites ) may result simply from a critical illness.

Supportive care (hydration, analgesics, antibiotics)