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Choledocholithiasis Can Present with Marked Transaminases Elevation: Systematic Review and Meta-Analysis
Mouhand F H Mohamed1, Khaled Elfert2, Neha Wadhavkar3
1Division of Medicine, The Warren Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI, 02903, USA. mouhand@brown.edu.
Digestive Diseases and Sciences
|June 3, 2023
Summary
Common bile duct stones can cause severe liver injury, with over a third of patients showing elevated liver enzymes (ALT/AST > 500 IU/L). Extreme elevations (ALT/AST > 1000 IU/L) are also observed in choledocholithiasis cases.
Area of Science:
- Hepatology
- Gastroenterology
- Internal Medicine
Background:
- Extreme transaminase elevation (>1000 IU/L) typically indicates hepatocellular injury from ischemia, drugs, or viral infections.
- Acute choledocholithiasis (common bile duct stones) can mimic severe hepatocellular injury with marked transaminase elevation, contrary to its usual cholestatic presentation.
Conclusions:
- This meta-analysis is the first to report the prevalence of severe hepatocellular injury in patients with common bile duct stones.
- Approximately one-third of choledocholithiasis patients present with ALT/AST > 500 IU/L, and levels > 1000 IU/L are not uncommon.
- In cases with clear evidence of choledocholithiasis, extensive work-up for alternative causes of severe transaminase elevation may be unnecessary.
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