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#4

ANSWER A.

Elevation in liver enzymes may result from biliary-induced pancreatitis, particularly when pressure from surrounding pancreatic inflammation impinges the common bile duct. Alanine aminotransferase (ALT) is the best single marker for a biliary etiology.  Levels 3 times greater than baseline support the diagnosis of biliary pancreatitis. The higher the level of ALT, the greater the specificity and predictive value for gallstones.  ALT levels more than 150 IU/L have 96% specificity and 95% positive predictive value for gallstone pancreatitis.

According to Ranson’s criteria, an elevated aspartate transaminase (AST) (B) is associated with a worse prognosis in patients with pancreatitis. An elevated AST, especially when greater than corresponding ALT level, is commonly seen in patients with alcoholic but not biliary pancreatitis. Elevated lipase (C) is specific for acute pancreatitis. At values 5 times the upper limit of normal, lipase is 60% sensitive and 100% specific. Mild elevations of bilirubin (D) are common in all types of pancreatitis (as well as many other liver disorders) and are not predictive of a biliary etiology.

Ref
Hemphill RR, Santen SA: Disorders of the Pancreas, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 7. St. Louis, Mosby, Inc., 2010, (Ch) 89:p 1177.

>>GO TO QUESTION 5

 

Comments   

# Mini Board Review: March 2013 EditionDiane Gilliland 2013-03-07 20:37
Thank you for putting together the questions for the mini board review. I find them very helpful!
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# Mini Board reviewDr Zahn 2013-03-10 09:37
Good review....but alot of medical info, very specific...not known when you are out for years in practice.
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# MDSam Morale 2013-03-11 17:06
Thanks for your effort. Nice to review uncommon diseases to keep us up to speed. It is amazing how many diseases, pathogens etc... have had their names changed : Granulomatosis with Polyangiitis (GPA) (formerly referred to as Wegener’s granulomatosis) .
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# Robert Ditrolio 2013-03-12 17:10
Excellent review questions. Please keep them coming in future issues!
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