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. 1985 Jan;201(1):68–75.

Biochemical identification of patients with gallstones associated with acute pancreatitis on the day of admission to hospital.

A D Mayer, M J McMahon
PMCID: PMC1250620  PMID: 2578276

Abstract

Current trends in the treatment of gallstone pancreatitis require rapid diagnosis of cholelithiasis. This study evaluates the diagnostic potential of plasma aspartate aminotransferase (AST), alkaline phosphatase, and bilirubin on the day of admission to hospital in 215 attacks of acute pancreatitis. The optimal diagnostic cut-off level for AST was 60 IU/1. A transient elevation above 60 IU/1 was recorded in 111 (84.1%) of 132 attacks associated with gallstones, but in only 12 (14.5%) of 83 attacks without stones, and was unrelated to the severity of the attack. Elevated levels of alkaline phosphatase and bilirubin were also more common in attacks associated with gallstones but were less reliable for the identification of cholelithiasis than AST. As a sensitive indicator of hepatocyte disruption, the early and transient rise in plasma AST is consistent with the concept of transient ampullary obstruction in gallstone pancreatitis, and may be useful in identifying patients who require urgent surgical or endoscopic disimpaction.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. ALBO R., SILEN W., GOLDMAN L. A critical clinical analysis of acute pancreatitis. Arch Surg. 1963 Jun;86:1032–1038. doi: 10.1001/archsurg.1963.01310120150021. [DOI] [PubMed] [Google Scholar]
  2. Acosta J. M., Ledesma C. L. Gallstone migration as a cause of acute pancreatitis. N Engl J Med. 1974 Feb 28;290(9):484–487. doi: 10.1056/NEJM197402282900904. [DOI] [PubMed] [Google Scholar]
  3. Acosta J. M., Pellegrini C. A., Skinner D. B. Etiology and pathogenesis of acute biliary pancreatitis. Surgery. 1980 Jul;88(1):118–125. [PubMed] [Google Scholar]
  4. Acosta J. M., Rossi R., Galli O. M., Pellegrini C. A., Skinner D. B. Early surgery for acute gallstone pancreatitis: evaluation of a systematic approach. Surgery. 1978 Apr;83(4):367–370. [PubMed] [Google Scholar]
  5. Adams J. T., Clermont G. H., Schwartz S. I. Serum glutamic oxalacetic transaminase activity in cholecystitis. Surgery. 1970 Sep;68(3):492–497. [PubMed] [Google Scholar]
  6. Addison N. V. The clinical value of ultrasound in biliary tract and pancreatic disease. Ann R Coll Surg Engl. 1979 Nov;61(6):448–451. [PMC free article] [PubMed] [Google Scholar]
  7. Blamey S. L., Osborne D. H., Gilmour W. H., O'Neill J., Carter D. C., Imrie C. W. The early identification of patients with gallstone associated pancreatitis using clinical and biochemical factors only. Ann Surg. 1983 Nov;198(5):574–578. doi: 10.1097/00000658-198311000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Burrell M. I., Avella J., Spiro H. M., Taylor K. J. Diagnostic imaging procedures in acute pancreatitis. Comparison of ultrasound, intravenous cholangiography, and oral cholecystography. JAMA. 1979 Jul 27;242(4):342–343. [PubMed] [Google Scholar]
  9. Ceska M., Birath K., Brown B. A new and rapid method for the clinical determination of alpha-amylase activities in human serum and urine. Optimal conditions. Clin Chim Acta. 1969 Dec;26(3):437–444. doi: 10.1016/0009-8981(69)90071-0. [DOI] [PubMed] [Google Scholar]
  10. Clermont R. J., Chalmers T. C. The transaminase tests in liver disease. Medicine (Baltimore) 1967 Mar;46(2):197–207. doi: 10.1097/00005792-196703000-00012. [DOI] [PubMed] [Google Scholar]
  11. DERITIS F., GIUSTI G., PICCININO F., CACCIATORE L. BIOCHEMICAL LABORATORY TESTS IN VIRAL HEPATITIS AND OTHER HEPATIC DISEASES. EVALUATION AND FOLLOW-UP. Bull World Health Organ. 1965;32:59–72. [PMC free article] [PubMed] [Google Scholar]
  12. Dammann H. G., Döpner M., von Wichert P., Harders H., Hornborstel H. Gallstones and acute pancreatitis. Lancet. 1980 Feb 9;1(8163):308–308. doi: 10.1016/s0140-6736(80)90799-0. [DOI] [PubMed] [Google Scholar]
  13. Dixon J. A., Hillam J. D. Surgical treatment of biliary tract disease associated with acute pancreatitis. Am J Surg. 1970 Sep;120(3):371–375. [PubMed] [Google Scholar]
  14. Elfström J. The timing of cholecystectomy in patients with gallstone pancreatitis. A retrospective analysis of 89 patients. Acta Chir Scand. 1978;144(7-8):487–490. [PubMed] [Google Scholar]
  15. Frey C. F. Gallstone pancreatitis. Surg Clin North Am. 1981 Aug;61(4):923–938. doi: 10.1016/s0039-6109(16)42489-8. [DOI] [PubMed] [Google Scholar]
  16. Gatelli Artigas J. M., Galindo Gali F., Palau Siscart M. C., Aused Faure M. R. Gallstones and acute pancreatitis. Lancet. 1981 Apr 25;1(8226):947–948. doi: 10.1016/s0140-6736(81)91645-7. [DOI] [PubMed] [Google Scholar]
  17. Glazer G., Murphy F., Clayden G. S., Lawrence R. G., Craig O. Radionuclide biliary scanning in acute pancreatitis. Br J Surg. 1981 Nov;68(11):766–770. doi: 10.1002/bjs.1800681105. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Graham D. F., Wyllie F. J. Prediction of gall-stone pancreatitis by computer. Br Med J. 1979 Feb 24;1(6162):515–517. doi: 10.1136/bmj.1.6162.515. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. HENRY R. J., CHIAMORI N., GOLUB O. J., BERKMAN S. Revised spectrophotometric methods for the determination of glutamic-oxalacetic transaminase, glutamic-pyruvic transaminase, and lactic acid dehydrogenase. Am J Clin Pathol. 1960 Oct;34:381–398. doi: 10.1093/ajcp/34.4_ts.381. [DOI] [PubMed] [Google Scholar]
  20. Imrie C. W., Benjamin I. S., Ferguson J. C., McKay A. J., Mackenzie I., O'Neill J., Blumgart L. H. A single-centre double-blind trial of Trasylol therapy in primary acute pancreatitis. Br J Surg. 1978 May;65(5):337–341. doi: 10.1002/bjs.1800650514. [DOI] [PubMed] [Google Scholar]
  21. JOHNSON H. C., Jr, MINOR B. D., THOMPSON J. A., WEENS H. S. Diagnostic value of intravenous cholangiography during acute cholecystitis and acute pancreatitis. N Engl J Med. 1959 Jan 22;260(4):158–161. doi: 10.1056/NEJM195901222600403. [DOI] [PubMed] [Google Scholar]
  22. KADEN V. G., HOWARD J. M., DOUBLEDAY L. C. Cholecystographic studies during and immediately following acute pancreatitis. Surgery. 1955 Dec;38(6):1082–1086. [PubMed] [Google Scholar]
  23. KIND P. R., KING E. J. Estimation of plasma phosphatase by determination of hydrolysed phenol with amino-antipyrine. J Clin Pathol. 1954 Nov;7(4):322–326. doi: 10.1136/jcp.7.4.322. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Kaplan M. M. Alkaline phosphatase. N Engl J Med. 1972 Jan 27;286(4):200–202. doi: 10.1056/NEJM197201272860407. [DOI] [PubMed] [Google Scholar]
  25. Kelly T. R. Gallstone pancreatitis: pathophysiology. Surgery. 1976 Oct;80(4):488–492. [PubMed] [Google Scholar]
  26. Kelly T. R. Gallstone pancreatitis: the timing of surgery. Surgery. 1980 Sep;88(3):345–350. [PubMed] [Google Scholar]
  27. Kim U., Sheth M. Optimal timing of surgical intervention in patients with acute pancreatitis associated with cholelithiasis. Surg Gynecol Obstet. 1980 Apr;150(4):499–501. [PubMed] [Google Scholar]
  28. King E. J., Armstrong A. R. A CONVENIENT METHOD FOR DETERMINING SERUM AND BILE PHOSPHATASE ACTIVITY. Can Med Assoc J. 1934 Oct;31(4):376–381. [PMC free article] [PubMed] [Google Scholar]
  29. Mayer A. D., McMahon M. J., Benson E. A., Axon A. T. Operations upon the biliary tract in patients with acute pancreatitis: aims, indications and timing. Ann R Coll Surg Engl. 1984 May;66(3):179–183. [PMC free article] [PubMed] [Google Scholar]
  30. McKay A. J., Imrie C. W., O'Neill J., Duncan J. G. Is an early ultrasound scan of value in acute pancreatitis? Br J Surg. 1982 Jul;69(7):369–372. doi: 10.1002/bjs.1800690704. [DOI] [PubMed] [Google Scholar]
  31. McMahon M. J., Pickford I. R. Biochemical prediction of gallstones early in an attack of acute pancreatitis. Lancet. 1979 Sep 15;2(8142):541–543. doi: 10.1016/s0140-6736(79)91610-6. [DOI] [PubMed] [Google Scholar]
  32. McMahon M. J., Playforth M. J., Pickford I. R. A compaative study of methods for the prediction of severity of attacks of acute pancreatitis. Br J Surg. 1980 Jan;67(1):22–25. doi: 10.1002/bjs.1800670107. [DOI] [PubMed] [Google Scholar]
  33. Osborne D. H., Imrie C. W., Carter D. C. Biliary surgery in the same admission for gallstone-associated acute pancreatitis. Br J Surg. 1981 Nov;68(11):758–761. doi: 10.1002/bjs.1800681103. [DOI] [PubMed] [Google Scholar]
  34. Paloyan D., Simonowitz D., Skinner D. B. The timing of biliary tract operations in patients with pancreatitis associated with gallstones. Surg Gynecol Obstet. 1975 Nov;141(5):737–739. [PubMed] [Google Scholar]
  35. Ranson J. H., Rifkind K. M., Turner J. W. Prognostic signs and nonoperative peritoneal lavage in acute pancreatitis. Surg Gynecol Obstet. 1976 Aug;143(2):209–219. [PubMed] [Google Scholar]
  36. Ranson J. H. The timing of biliary surgery in acute pancreatitis. Ann Surg. 1979 May;189(5):654–663. doi: 10.1097/00000658-197905000-00016. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Safrany L., Cotton P. B. A preliminary report: urgent duodenoscopic sphincterotomy for acute gallstone pancreatitis. Surgery. 1981 Apr;89(4):424–428. [PubMed] [Google Scholar]
  38. Smith R., Williams R., Cotton P. B. Gallstone pancreatitis with normal biliary radiology. Br J Surg. 1976 Nov;63(11):861–863. doi: 10.1002/bjs.1800631106. [DOI] [PubMed] [Google Scholar]
  39. Stone H. H., Fabian T. C., Dunlop W. E. Gallstone pancreatitis: biliary tract pathology in relation to time of operation. Ann Surg. 1981 Sep;194(3):305–312. doi: 10.1097/00000658-198109000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Tondelli P., Stutz K., Harder F., Schuppisser J. P., Allgöwer M. Acute gallstone pancreatitis: best timing for biliary surgery. Br J Surg. 1982 Dec;69(12):709–710. doi: 10.1002/bjs.1800691208. [DOI] [PubMed] [Google Scholar]
  41. Van Gossum A., Seferian V., Rodzynek J. J., Wettendorff P., Cremer M., Delcourt A. Early detection of biliary pancreatitis. Dig Dis Sci. 1984 Feb;29(2):97–101. doi: 10.1007/BF01317048. [DOI] [PubMed] [Google Scholar]
  42. WROBLEWSKI F. The clinical significance of transaminase activities of serum. Am J Med. 1959 Dec;27:911–923. doi: 10.1016/0002-9343(59)90175-5. [DOI] [PubMed] [Google Scholar]
  43. Welch J. P., White C. E. Acute pancreatitis of biliary origin: is urgent operation necessary? Am J Surg. 1982 Jan;143(1):120–126. doi: 10.1016/0002-9610(82)90141-6. [DOI] [PubMed] [Google Scholar]
  44. Wettendorff P., van Gossum A., Delcourt A. Gallstones and acute hepatitis. Lancet. 1981 Mar 21;1(8221):675–675. doi: 10.1016/s0140-6736(81)91603-2. [DOI] [PubMed] [Google Scholar]

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