Document Detail

Alanine transaminase rather than abdominal ultrasound alone is an important investigation to justify cholecystectomy in patients presenting with acute pancreatitis.
MedLine Citation:
PMID:  20590910     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: The aims of this study were to investigate the predictive value of an elevated level of alanine transaminase (ALT) for biliary acute pancreatitis (AP) and to reconsider the role of abdominal ultrasound (AUS).
METHODS: All patients admitted to Christchurch Public Hospital with AP between July 2005 and December 2008 were identified from a prospectively collected database. Peak ALT within 48 h of presentation was recorded. Aetiology was determined on the basis of history, AUS and other relevant investigations.
RESULTS: A total of 543 patients met the inclusion criteria. Patients with biliary AP had significantly higher median (range) ALT than those with non-biliary causes (200 units/l [63-421 units/l] vs. 33 units/l [18-84 units/l]; P < 0.001). An ALT level of >300 units/l had a sensitivity of 36%, specificity of 94%, positive predictive value of 87% and positive likelihood ratio of 5.6 for gallstones. An elevated ALT and negative AUS had a probability of 21-80% for gallstones.
CONCLUSIONS: An elevated ALT strongly supports a diagnosis of gallstones in AP. Abdominal ultrasound effectively confirms this diagnosis; however, a negative ultrasound in the presence of a raised ALT does not exclude gallstones. In some patients consideration could be given to proceeding to laparoscopic cholecystectomy based on ALT alone.
Kerry Anderson; Lisa A Brown; Philip Daniel; Saxon J Connor
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  HPB : the official journal of the International Hepato Pancreato Biliary Association     Volume:  12     ISSN:  1477-2574     ISO Abbreviation:  HPB (Oxford)     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-07-01     Completed Date:  2011-02-09     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  100900921     Medline TA:  HPB (Oxford)     Country:  England    
Other Details:
Languages:  eng     Pagination:  342-7     Citation Subset:  IM    
Department of Surgery, Christchurch Hospital, Christchurch, New Zealand.
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MeSH Terms
Age Factors
Alanine Transaminase / blood*
Cholecystectomy, Laparoscopic*
Clinical Enzyme Tests*
Gallstones / complications,  diagnosis*,  radiography,  surgery*,  ultrasonography
Hospitals, Public
Likelihood Functions
Logistic Models
Middle Aged
New Zealand
Odds Ratio
Pancreatitis / diagnosis,  etiology*,  surgery
Patient Selection
Predictive Value of Tests
Prospective Studies
Risk Assessment
Risk Factors
Sex Factors
Tomography, X-Ray Computed
Reg. No./Substance:
EC Transaminase
Comment In:
HPB (Oxford). 2011 Mar;13(3):221; author reply 222   [PMID:  21309941 ]

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