Utility of leucocytes, inflammatory markers and pancreatic enzymes as indicators of gangrenous cholecystitis.

BACKGROUND: Acute cholecystitis is an emergency condition. If not promptly diagnosed and properly managed, the complication of gangrenous cholecystitis may develop, which may be a life-threatening complication. OBJECTIVES: The study aims to examine various characteristics and physiological parameters in patients diagnosed with acute cholecystitis to evaluate if significant predictive factors exist for the differential diagnosis of gangrenous cholecystitis. MATERIALS AND METHODS: This was a retrospective study included patients with acute cholecystitis diagnosis, who presented to 'blinded for peer review' from 1 January 2010 to 1 January 2017. Parameters evaluated included liver function tests, complete cell count, C reactive protein, erythrocyte sedimentation rate (ESR), amylase and lipase levels, as well as medical history, and presenting clinical signs. Cases were divided according to whether or not there was a histopathological diagnosis of gangrenous cholecystitis. RESULTS: A total of 186 (54.5%) female and 155 (45.5%) male cases were examined. Patients with gangrenous cholecystitis tended to be male, showed a significantly higher white cell count, higher neutrophil percentage, lower lymphocyte percentage and higher ESR compared with patients without gangrenous cholecystitis. However, serum amylase and lipase demonstrated no differential diagnostic utility CONCLUSION: Male patients with a high ESR level, high total leucocyte count with a relative high proportion of neutrophils and a low proportion of lymphocytes were found to be at increased risk of the presence of gangrenous cholecystitis.

Liver enzyme elevation and normal pulmonary function in an adult with a declining forced expiratory volume in 1 second.

This article presents a case report of a 41-year-old male firefighter with cholecystitis and a history of mildly elevated alanine aminotransferase. Liver biopsy showed periodic acid Schiff-positive, diastase-resistant periportal globules. Retrospective review of clinical data revealed progressive lung function decline despite absent pulmonary symptoms and normal pulmonary function testing. The following disorders should be considered in any patient with elevated transaminases without an apparent etiology: viral hepatitides, medication toxicity, autoimmune hepatitis, alcohol-induced hepatic injury, and alpha-1-antitrypsin deficiency.