elevation of serum alkaline phosphatase in acute cholecystitis

Q: Elevation of alkaline phosphatase in acute cholecystitis raises the possibility of? - Select one

A) cystic duct obstruction

B) biliary duct obstruction 

Answer: B

In uncomplicated acute cholecystitis, elevation of serum total bilirubin and alkaline phosphatase concentrations is uncommon because the obstruction is typically limited to the cystic duct. If clinical signs are present with elevated serum total bilirubin and alkaline phosphatase concentrations, concern should be raised for possible biliary obstruction and/or more complicated situations, such as cholangitis, choledocholithiasis, or Mirizzi syndrome, where a gallstone is impacted in the distal cystic duct, causing extrinsic compression of the common bile duct.

#hepatology

References:

1. Siddique A, Kowdley KV. Approach to a patient with elevated serum alkaline phosphatase. Clin Liver Dis. 2012 May;16(2):199-229. doi: 10.1016/j.cld.2012.03.012. Epub 2012 Apr 6. PMID: 22541695; PMCID: PMC3341633.

2. Pellegrini CA, Thomas MJ, Way LW. Bilirubin and alkaline phosphatase values before and after surgery for biliary obstruction. Am J Surg. 1982 Jan;143(1):67-73. doi: 10.1016/0002-9610(82)90131-3. PMID: 7053658.

3. Toda G, Ikeda Y, Kako M, Oka H, Oda T. Mechanism of elevation of serum alkaline phosphatase activity in biliary obstruction: an experimental study. Clin Chim Acta. 1980 Oct 23;107(1-2):85-96. doi: 10.1016/0009-8981(80)90417-9. PMID: 7428180.