EFFICACY OF LIVER FUNCTION TEST IN PATIENTS WITH SYMPTOMATIC GALL STONE DISEASE

Abstract

Background: Cholelithiasis is a common clinical problem in surgical practice all over the world. Liver function tests (LFT’s) are routinely performed in patients undergoing cholecystectomy for symptomatic gall stones.

Objective: To evaluate the effectiveness of routine LFTs in patients with symptomatic gall stones attending Shridev Suman Subharti Medical College attached with Dr. K.K. Bhatnagar Memorial Subharti Hospital, Dehradun, Uttarakhand, India

Material and Methods: The present prospective observational study was conducted from December 2016 to November 2017 in the Dept. of Surgery in collaboration with Dept. of Biochemistry at Shridev Suman Subharti Medical College attached with Dr. K.K. Bhatnagar Memorial Subharti Hospital, Dehradun, Uttarakhand, India. All patients clinically diagnosed with symptomatic cholelithiasis were included in the study. Patients with past and present history of jaundice, pancreatitis, cholangitis and abnormal calibre common bile duct on ultrasonography (more than 8mm) were excluded from the study. Data regarding relevant history, clinical examination findings, LFT’s and ultrasound examination findings were analyzed and noted in pre-designed proforma.

Results: Study composed of 120 patients comprising 100(83.33%) female and 20(16.67%) male with the mean age of 45±25 years. Out of 120 patients, 85(70.83%) presented as chronic calculous cholecystitis, 29(24.17%) as biliary colic and 6(5.00%) with acute calculous cholecystitis. The LFT’s were within normal range in 107(89.16%) patient, which labeled as group A. In group A, 80(74.76%) patients were presented as chronic calculous cholecystitis, 24 (22.42%) as biliary colic and 3(2.8%) as acute calculous cholecystitis. The levels of LFT’s were found abnormal in 13 patients (8.33%) which is labeled as group B. In group B, clinical presentation of  2 (40.00%) patients were as chronic calculous cholecystitis, 8(30.00%) patients as biliary colic & 3(30.00%) patients as acute calculous cholecystitis. Parameters of LFTs, Bilirubin were elevated in 2, AST in 3 and ALP in 8 patients. All patients from either group had normal Common Bile Duct (CBD) caliber on preoperative ultrasound examination and per operatively (in open surgery), no CBD dilatation or palpable calculi.

Conclusion: Routine LFT’s in preoperative assessment of symptomatic cholelithiasis usually reveals normal findings and is not recommended as a good predictive marker for the detection of silent CBD calculi.

Keywords: Cholelithiasis, Choledocholithiasis, Common bile duct (CBD), LFT, Cholecystectomy, Laparoscopic