Fatima Huda, Avasthi Deepti
Internal Medicine, St. Vincent Mercy Medical Center, Toledo, USA.
Cureus. 2021 Jul 2;13(7):e16102. doi: 10.7759/cureus.16102. eCollection 2021 Jul.
The hepatocellular function can be evaluated using aspartate aminotransferase (AST) and alanine aminotransferase (ALT) which are biochemical markers of the liver. Whenever there is an ischemic, toxic, or inflammatory injury to the liver, necrosis of the hepatocytes occurs and these biochemical markers are released into the circulation, showing an acute elevation in serum levels. In this case report, we discuss the unique clinical presentation of a female patient who came to the Emergency Room (ER) with acute onset chest pain with laboratory findings of elevated serum aminotransferases and cholestatic markers and was ultimately diagnosed with chronic cholecystitis. The usual clinical presentation associated with extremely elevated levels of liver enzymes can be one of three cases: acute viral hepatitis, toxin-induced liver injury, or acute ischemic insult to the liver. However, our patient was diagnosed with chronic cholecystitis despite her unique initial presentation of acute, severe transaminitis. While one may find elevated liver enzyme levels in acute cholecystitis, owing to the sudden nature of the inflammatory process, chronic cholecystitis is not known to cause high levels of serum amino transaminases or fulminant liver failure. Our case report indicates a diverse phenotype of chronic cholecystitis with an unusual presentation of acute, severe transaminitis. It helps expand the differential diagnoses of acute elevation of liver function tests (LFTs). Further studies are needed to explore the pathology behind chronic cholecystitis in order to understand its impact on liver damage.
肝细胞功能可以通过天冬氨酸转氨酶（AST）和丙氨酸转氨酶（ALT）来评估，这两种酶是肝脏的生化标志物。每当肝脏发生缺血、中毒或炎症损伤时，肝细胞就会坏死，这些生化标志物会释放到循环系统中，导致血清水平急剧升高。在本病例报告中，我们讨论了一名女性患者的独特临床表现，该患者因急性胸痛前往急诊室（ER），实验室检查发现血清转氨酶和胆汁淤积标志物升高，最终被诊断为慢性胆囊炎。与肝酶水平极度升高相关的常见临床表现可能是以下三种情况之一：急性病毒性肝炎、毒素诱导的肝损伤或肝脏急性缺血性损伤。然而，尽管我们的患者最初表现为急性、严重的转氨酶升高，但最终被诊断为慢性胆囊炎。虽然在急性胆囊炎中可能会发现肝酶水平升高，但由于炎症过程的突发性，慢性胆囊炎通常不会导致血清转氨酶水平升高或暴发性肝衰竭。我们的病例报告表明慢性胆囊炎存在多种表型，表现为急性、严重转氨酶升高这种不寻常的情况。它有助于扩展对肝功能检查（LFTs）急性升高的鉴别诊断。需要进一步研究来探索慢性胆囊炎背后的病理机制，以便了解其对肝损伤的影响。
