From the Guidelines
Elevated Alanine Transaminase (ALT) after cholecystectomy is most likely caused by hepatocellular injury due to the surgical procedure itself, with CO2 pneumoperitoneum being a potential contributing factor 1.
Possible Causes of Elevated ALT
- Hepatocellular injury caused by the surgical procedure
- CO2 pneumoperitoneum
- Other potential causes of elevated ALT include:
- Fatty liver disease
- Acute or chronic viral hepatitis
- Acute Budd-Chiari syndrome
- Ischemic hepatitis
- Autoimmune hepatitis
- Hemochromatosis
- Medications/toxins
- Alpha1-antitrypsin deficiency
- Wilson disease
Diagnosis and Evaluation
In clinical practice, postoperative biochemical investigations, including liver function tests, are considered when difficulties are encountered during the intervention or in the presence of postoperative clinical signs suggestive of complications 1.
Laboratory Tests
- Serum levels of direct and indirect bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), gamma-glutamyl transpeptidase (GGT), and albumin
- Complete blood count (CBC)
Interpretation of Results
- Elevated ALT levels are indicative of liver damage, with normal levels ranging from 19 to 33 IU/L (0.32-0.55 mkat/L) in men and women 1
- The severity of abnormal aminotransferase can be classified as mild, moderate, or severe, with moderate and severe elevations indicating significant liver damage 1
From the Research
Causes of Elevated Alanine Transaminase (ALT) after Cholecystectomy
- Elevated ALT levels after cholecystectomy can be attributed to several factors, including:
- CO2 pneumoperitoneum, which can cause negative effects on hepatic blood flow 2, 3, 4, 5, 6
- Surgical manipulations, which can cause transient elevation of hepatic transaminases 6
- Diathermy, which can cause thermal injury to the liver 6
- Patient position, which can cause venous stasis and thromboembolism 6
- Arterial injury, which can cause ischemia to the liver 6
- The elevation of ALT levels is usually transient and returns to normal within 3-7 days after the procedure 3, 4, 5, 6
- The changes in liver function tests (LFTs) after laparoscopic cholecystectomy are generally considered clinically insignificant in patients with normal hepatic function 2, 3, 4, 5, 6
- However, in patients with pre-existing liver disease or hepatic insufficiency, the elevation of ALT levels after cholecystectomy may be more significant and require closer monitoring 2, 5