Hypertransaminasemia in choledocholithiasis

Abstract

Introduction. Acute choledocholithiasis occurs when a stone impacts the distal bile duct. It usually manifests with a cholestatic pattern, with a mild or moderate increase in ASL and ALT. However, series of cases of choledocholithiasis have been reported with AST and ALT values >400 IU/L, which may lead the physician to consider hepatitis as a presumptive diagnosis, instead of choledocholithiasis. This scoping review is intended to explain this form of presentation, and to sugges the steps that the clinician should take to identify these cases and provide a timely and accurate diagnosis. Methodology. A scoping review was carried out using PubMed, BIREME (BVS), LILACS and Google Scholar search engines, with the MeSH words “choledocholithiasis”, “transaminases” and the “and” connector, as well as the DeCS terms “coledocolitiasis”, “transaminasas” and the “y” connector. Results. A total of 20 studies related to the topic of choledocholithiasis and elevation of AST or ALT >400 IU/L were included in the analysis. It was found that the increase in AST or ALT between 400 IU/L and 500 IU/L occurred in 5.76% of the cases, values between 500 IU/L and 800 IU/L in 36.8%, between 800 IU/L and 1,000 IU/L in 9%, and values >1,000 IU/L in 6.43% of the cases. Conclusion. Choledocholithiasis with elevated AST or ALT transaminases >400 IU/L is an occurrence that should be taken into account, particularly in young people, and in those without a history of previous liver problems. It is necessary for the specialist to have a presumptive diagnosis of choledocholithiasis, even with transaminase levels that may suggest hepatitis, and to analyze the different variables that are essential to achieve an accurate diagnosis.