PMID- 15625352
OWN - NLM
STAT- MEDLINE
DCOM- 20050512
LR  - 20151119
IS  - 1460-2725 (Print)
IS  - 1460-2393 (Linking)
VI  - 98
IP  - 1
DP  - 2005 Jan
TI  - Contrasting liver function test patterns in obstructive jaundice due to biliary 
      strictures [corrected] and stones.
PG  - 35-40
AB  - BACKGROUND: Obstructive jaundice is believed to be characterized by abnormalities 
      of alkaline phosphatase (ALP), rather than aspartate transaminase (AST). AIM: To 
      compare liver function tests (LFTs) in obstructive jaundice due to malignant 
      strictures with those of jaundice due to gallstones. METHODS: LFTs were measured 
      immediately before endoscopic retrograde cholangio-pancreatography (ERCP) in 207 
      jaundiced patients. Group 1 (n = 69) had malignant strictures, group 2 (n = 97) 
      had common bile duct stone(s), and group 3 (n = 41) appeared to have recently 
      passed a stone. LFTs in groups 2 and 3 were also analysed at maximal liver enzyme 
      derangement, maximum hyperbilirubinaemia and during acute pain episodes. RESULTS: 
      Group 1 had higher median bilirubin, AST and ALP levels than groups 2 or 3 (p < 
      0.001). In group 1, median rise in ALP exceeded that in AST (4.3 x normal upper 
      limit (NUL) vs. 2.6 x NUL, p < 0.01), but in groups 2 and 3, AST and ALP were 
      similarly elevated (both approximately 2 x NUL). At the time of maximum enzyme 
      derangement in groups 2 and 3, median AST elevation (4.4 x NUL, 185 IU/l) 
      exceeded that for ALP (2.4 x NUL, 276 U/l), (p < 0.001), and this was also true 
      at peak hyperbilirubinaemia in these groups (AST 3.6 x NUL, ALP 2.4 x NUL, p < 
      0.01. Similarly, severe pain episodes in groups 2 and 3 were accompanied by 
      greater elevations in bilirubin and AST, but not ALP, compared with levels at 
      ERCP. DISCUSSION: 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.
FAU - Hayat, J O
AU  - Hayat JO
AD  - Department of Gstroenterology, Wycombe Hospital, Queen Alexandra Road, High 
      Wycombe, Bucks HP11 2TT, UK.
FAU - Loew, C J
AU  - Loew CJ
FAU - Asrress, K N
AU  - Asrress KN
FAU - McIntyre, A S
AU  - McIntyre AS
FAU - Gorard, D A
AU  - Gorard DA
LA  - eng
PT  - Journal Article
PL  - England
TA  - QJM
JT  - QJM : monthly journal of the Association of Physicians
JID - 9438285
RN  - 0 (Biomarkers)
RN  - EC 2.6.1.1 (Aspartate Aminotransferases)
RN  - EC 3.1.3.1 (Alkaline Phosphatase)
SB  - IM
EIN - QJM. 2005 Mar;98(3):238
MH  - Aged
MH  - Aged, 80 and over
MH  - Alkaline Phosphatase/blood
MH  - Aspartate Aminotransferases/blood
MH  - Bile Duct Neoplasms/blood/*complications/diagnosis
MH  - Biomarkers/blood
MH  - Cholangiopancreatography, Endoscopic Retrograde
MH  - Diagnosis, Differential
MH  - Female
MH  - Gallstones/blood/*complications/diagnosis
MH  - Humans
MH  - Hyperbilirubinemia/etiology
MH  - Jaundice, Obstructive/enzymology/*etiology/physiopathology
MH  - Liver Function Tests/methods
MH  - Male
MH  - Middle Aged
MH  - Pain/blood/etiology
MH  - Retrospective Studies
EDAT- 2004/12/31 09:00
MHDA- 2005/05/13 09:00
CRDT- 2004/12/31 09:00
PHST- 2004/12/31 09:00 [pubmed]
PHST- 2005/05/13 09:00 [medline]
PHST- 2004/12/31 09:00 [entrez]
AID - 98/1/35 [pii]
AID - 10.1093/qjmed/hci004 [doi]
PST - ppublish
SO  - QJM. 2005 Jan;98(1):35-40. doi: 10.1093/qjmed/hci004.