Can cholecystitis cause elevated Liver Function Tests (LFTs)?

From the Guidelines

Yes, cholecystitis can cause elevated liver function tests (LFTs). Acute inflammation of the gallbladder often leads to mild to moderate elevations in liver enzymes, particularly alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), and sometimes aminotransferases (ALT and AST) 1. These elevations typically occur when the inflammatory process extends beyond the gallbladder or when there is associated bile duct obstruction from stones or edema. The pattern of elevation usually shows a cholestatic picture with ALP and GGT rising more prominently than transaminases.

Some key points to consider:

• In uncomplicated cholecystitis, these elevations are typically modest, with values rarely exceeding 2-3 times the upper limit of normal 1.
• If cholecystitis is complicated by choledocholithiasis (common bile duct stones) or ascending cholangitis, LFT abnormalities can be more pronounced 1.
• Bilirubin levels may also rise if there is significant biliary obstruction 1.
• These laboratory abnormalities generally resolve with appropriate treatment of the underlying cholecystitis, which typically includes antibiotics such as piperacillin-tazobactam or a combination of ceftriaxone and metronidazole, followed by cholecystectomy when clinically appropriate 1.

It's worth noting that the diagnostic accuracy of LFTs for common bile duct stones (CBDS) is limited, with a sensitivity of 0.42 and a specificity of 0.97 for bilirubin at a cut-off of greater than twice the normal limit 1. Therefore, elevated LFTs or bilirubin should not be used as the only method to identify CBDS in patients with acute calculus cholecystitis, and further diagnostic tests should be performed 1.

From the Research

Elevated LFTs in Cholecystitis

• Cholecystitis, an inflammation of the gallbladder, can cause elevated Liver Function Tests (LFTs) due to the inflammatory process affecting liver function enzymes 2.
• Studies have shown that elevated serum bilirubin, aminotransferases, and alkaline phosphatase levels can be observed in patients with acute cholecystitis, with frequencies ranging from 22% to 34% 3.
• The predictive value of LFTs in diagnosing common bile duct stones in patients with cholecystitis has been investigated, with gamma-glutamyl transpeptidase (GGT) showing high specificity and positive predictive value 4.

LFTs as Predictors of Common Bile Duct Stones

• Elevated LFTs, particularly GGT, can be used to identify high-risk patients who may benefit from further imaging to exclude choledocholithiasis 4.
• Abnormal LFTs are strong predictors for the presence of common bile duct stones in patients with acute cholecystitis, with odds ratios ranging from 3.61 to 4.90 5.
• However, normal LFTs should be interpreted with caution, as some patients with acute cholecystitis and common bile duct stones may not present with characteristic abnormalities in LFT results 5.

Clinical Implications

• The management of gallstones and acute cholecystitis in patients with liver cirrhosis requires careful consideration of the patient's underlying condition and the potential risks of surgery 6.
• Early cholecystectomy or drainage procedure with delayed cholecystectomy is the current standard of treatment for acute cholecystitis, but the treatment of biliary conditions in cirrhotic patients can be challenging due to systemic effects and local anatomic consequences related to cirrhosis 6.