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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.
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.
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