Enzyme pattern of biliary colic: A counterintuitive picture

Figure 1 Flow chart illustrating case selection process. Of 1039 patients who presented to the emergency department (ED) of Share’e Zedek Medical Center during 23 mo (2012-2013) with various forms of acute biliary disease, 100 who were designated in the ED as having Biliary Colic and who fulfilled study criteria, were selected sequentially for analysis of concomitant serum bilirubin and enzyme temporal patterns.

Figure 2 Time intervals between serological liver tests (hours). Time interval data in hours, are shown as means. Means ± SDs, and ranges (i.e., minima to maxima), above the bars.

Figure 3 Comparison of relative percent changes (per hour) in bilirubin and liver enzymes, between serial tests. Percent change per hour is shown for these five variables. ^a,cDenote significant statistical difference from ALT and AST respectively in the same time frame (i.e., ALT between test one and two compared with AST between test one and two). The number of cases in the analysis in the different time frames is shown on the top right. ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; GGT: Gamma-glutamyl transferase; ALKP: Alkaline phosphatase.

Figure 4 Time trends in percent changes of bilirubin and liver enzymes with serial testing. Time between tests is represented using the average time interval between tests (as seen in Figure 2). The hourly percent change between each test was multiplied by this interval, to provide a graphic presentation of the enzyme patterns. The intersection of the axes represents the first test and the following points represent each change from the previous result. For example, bilirubin increased by 20% between tests one and two and decreased by 15% between tests two and three; therefore, the next point is 5%. ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; GGT: Gamma-glutamyl transferase; ALKP: Alkaline phosphatase.