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Duration of Pain Is Correlated With Elevation in Liver Function Tests in Patients With Symptomatic Choledocholithiasis

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dc.contributor.author Sharara A.I.
dc.contributor.author Mansour N.M.
dc.contributor.author El-Hakam M.
dc.contributor.author Ghaith O.
dc.contributor.author El Halabi M.
dc.contributor.editor
dc.date Dec-2010
dc.date.accessioned 2017-10-05T15:39:32Z
dc.date.available 2017-10-05T15:39:32Z
dc.date.issued 2010
dc.identifier 10.1016/j.cgh.2010.08.021
dc.identifier.isbn
dc.identifier.issn 15423565
dc.identifier.uri http://hdl.handle.net/10938/16939
dc.description.abstract Background and Aims: We assessed the temporal relationship between abdominal pain and elevation in liver function tests (LFTs) in patients with acute symptomatic choledocholithiasis. Methods: Retrospective study of patients that presented within 12 hours of pain onset and were subsequently found to have choledocholithiasis. Results: We identified 40 patients with complete medical records. Levels of aspartate and alanine aminotransferases (AST and ALT) correlated with duration of pain (Pearson correlation, r = 0.633 and 0.622 respectively, P 001 for both); the correlation was not as strong for γ-glutamyl transpeptidase (GGT) (r = 0.326, P = 046) and was not significant for alkaline phosphatase or bilirubin. This temporal association was stronger in patients that had undergone cholecystectomy versus those with intact gallbladders (for ALT, r = 0.603 vs r = 0.311, respectively). Eighteen patients, evaluated within 6 hours of pain, had normal or minimal alterations in LFTs; transabdominal ultrasound was abnormal in 6 (sensitivity 33.3percent). All had repeat LFTs within 24 hours (mean 10.3 ± 6.9 hours later) and large increases in ALT and aspartate aminotransferase levels (mean 10.5- and 6.8-fold respectively; P 01 for both), intermediate increases in glutamyl transpeptidase levels, (mean 4-fold, P 05), and no changes in alkaline phosphatase levels. This significant increase in LFTs was the only indication of biliary pathology before endoscopy in 11-18 patients. Conclusions: Increasing duration of pain is associated with increasing LFTs (particularly transaminases) in patients with acute symptomatic choledocholithiasis. Patients with normal LFTs and ultrasound upon presentation should have repeat LFTs if biliary pain is suspected. The absence of significant biochemical abnormalities within the first 24 hours makes the diagnosis of symptomatic choledocholithiasis unlikely. © 2010 AGA Institute.
dc.format.extent
dc.format.extent Pages: (1077-1082)
dc.language English
dc.publisher NEW YORK
dc.relation.ispartof Publication Name: Clinical Gastroenterology and Hepatology; Publication Year: 2010; Volume: 8; no. 12; Pages: (1077-1082);
dc.relation.ispartofseries
dc.relation.uri
dc.source Scopus
dc.subject.other
dc.title Duration of Pain Is Correlated With Elevation in Liver Function Tests in Patients With Symptomatic Choledocholithiasis
dc.type Article
dc.contributor.affiliation Sharara, A.I., Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
dc.contributor.affiliation Mansour, N.M., Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
dc.contributor.affiliation El-Hakam, M., Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
dc.contributor.affiliation Ghaith, O., Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
dc.contributor.affiliation El Halabi, M., Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
dc.contributor.authorAddress Sharara, A.I.; Division of Gastroenterology, American University of Beirut Medical Center, P.O. Box 11-0236-16-B, Beirut, Lebanon; email: as08@aub.edu.lb
dc.contributor.authorCorporate University: American University of Beirut Medical Center; Faculty: Faculty of Medicine; Department: Internal Medicine; Division: Gastroenterology and Hepatology;
dc.contributor.authorDepartment Internal Medicine
dc.contributor.authorDivision Gastroenterology and Hepatology
dc.contributor.authorEmail as08@aub.edu.lb
dc.contributor.authorFaculty Faculty of Medicine
dc.contributor.authorInitials Sharara, AI
dc.contributor.authorInitials Mansour, NM
dc.contributor.authorInitials El-Hakam, M
dc.contributor.authorInitials Ghaith, O
dc.contributor.authorInitials El Halabi, M
dc.contributor.authorOrcidID
dc.contributor.authorReprintAddress Sharara, AI (reprint author), Amer Univ Beirut, Div Gastroenterol, Med Ctr, Dept Internal Med, POB 11-0236-16-B, Beirut, Lebanon.
dc.contributor.authorResearcherID
dc.contributor.authorUniversity American University of Beirut Medical Center
dc.description.cited ABBRUZZE.A, 1969, AM J DIG DIS, V14, P332, DOI 10.1007-BF02235945; ANCIAUX ML, 1986, DIGEST DIS SCI, V31, P449, DOI 10.1007-BF01320306; CSENDES A, 1988, ARCH SURG-CHICAGO, V123, P697; Dittrick George, 2005, Proc (Bayl Univ Med Cent), V18, P211; FUNCHJENSEN P, 1987, SCAND J GASTROENTERO, V22, P243, DOI 10.3109-00365528708991887; GEENEN JE, 1980, GASTROENTEROLOGY, V78, P317; Jeon Won Joong, 2006, Korean J Gastroenterol, V47, P213; MESHKINPOUR H, 1984, GASTROENTEROLOGY, V87, P759; Nathwani RA, 2005, AM J GASTROENTEROL, V100, P295, DOI 10.1111-j.1572-0241.2005.40793.x; OCONNOR HJ, 1986, GASTROINTEST RADIOL, V11, P161, DOI 10.1007-BF02035060; Onken JE, 1996, AM J GASTROENTEROL, V91, P762; Rosenblatt ML, 2001, GASTROINTEST ENDOSC, V54, P697, DOI 10.1067-mge.2001.118946; Roston AD, 1997, GASTROINTEST ENDOSC, V45, P394, DOI 10.1016-S0016-5107(97)70150-0; STRASBER.SM, 1971, GASTROENTEROLOGY, V61, P357; STRASBER.SM, 1971, SURGERY, V70, P140; TOOULI J, 1982, GASTROENTEROLOGY, V82, P111; Torsoli A, 1990, Scand J Gastroenterol Suppl, V175, P52; TOYOTA N, 1984, LAB INVEST, V50, P536; Varghese JC, 2000, CLIN RADIOL, V55, P25, DOI 10.1053-crad.1999.0319; Watanabe N, 2007, J GASTROEN HEPATOL, V22, P1983, DOI 10.1111-j.1440-1746.2006.04623.x
dc.description.citedCount 5
dc.description.citedTotWOSCount 4
dc.description.citedWOSCount 4
dc.format.extentCount 6
dc.identifier.articleNo
dc.identifier.coden CGHLA
dc.identifier.pubmedID 20831901
dc.identifier.scopusID 78649702885
dc.identifier.url
dc.publisher.address 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA
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dc.relation.ispartofConferenceDate
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dc.relation.ispartofConferenceLoc
dc.relation.ispartofConferenceSponsor
dc.relation.ispartofConferenceTitle
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dc.relation.ispartOfISOAbbr Clin. Gastroenterol. Hepatol.
dc.relation.ispartOfIssue 12
dc.relation.ispartOfPart
dc.relation.ispartofPubTitle Clinical Gastroenterology and Hepatology
dc.relation.ispartofPubTitleAbbr Clin. Gastroenterol. Hepatol.
dc.relation.ispartOfSpecialIssue
dc.relation.ispartOfSuppl
dc.relation.ispartOfVolume 8
dc.source.ID WOS:000285412500019
dc.type.publication Journal
dc.subject.otherAuthKeyword Biliary
dc.subject.otherAuthKeyword Common Bile Duct
dc.subject.otherAuthKeyword Sphincter of Oddi
dc.subject.otherAuthKeyword Stones
dc.subject.otherChemCAS alanine aminotransferase, 9000-86-6, 9014-30-6
dc.subject.otherChemCAS alkaline phosphatase, 9001-78-9
dc.subject.otherChemCAS aspartate aminotransferase, 9000-97-9
dc.subject.otherChemCAS bilirubin, 18422-02-1, 635-65-4
dc.subject.otherChemCAS gamma glutamyltransferase, 85876-02-4
dc.subject.otherChemCAS Enzymes
dc.subject.otherIndex alanine aminotransferase
dc.subject.otherIndex alkaline phosphatase
dc.subject.otherIndex aspartate aminotransferase
dc.subject.otherIndex bilirubin
dc.subject.otherIndex gamma glutamyltransferase
dc.subject.otherIndex abdominal pain
dc.subject.otherIndex adult
dc.subject.otherIndex article
dc.subject.otherIndex cholecystectomy
dc.subject.otherIndex clinical article
dc.subject.otherIndex common bile duct stone
dc.subject.otherIndex disease duration
dc.subject.otherIndex echography
dc.subject.otherIndex endoscopy
dc.subject.otherIndex female
dc.subject.otherIndex human
dc.subject.otherIndex liver function test
dc.subject.otherIndex male
dc.subject.otherIndex Abdominal Pain
dc.subject.otherIndex Adult
dc.subject.otherIndex Aged
dc.subject.otherIndex Choledocholithiasis
dc.subject.otherIndex Enzymes
dc.subject.otherIndex Female
dc.subject.otherIndex Humans
dc.subject.otherIndex Liver
dc.subject.otherIndex Liver Diseases
dc.subject.otherIndex Male
dc.subject.otherIndex Middle Aged
dc.subject.otherIndex Retrospective Studies
dc.subject.otherIndex Time Factors
dc.subject.otherKeywordPlus BILE-DUCT STONES
dc.subject.otherKeywordPlus BILIARY PRESSURE
dc.subject.otherKeywordPlus ODDI MANOMETRY
dc.subject.otherKeywordPlus SPHINCTER
dc.subject.otherKeywordPlus CHOLANGIOGRAPHY
dc.subject.otherKeywordPlus PRIMATE
dc.subject.otherWOS Gastroenterology and Hepatology


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