Duration of Pain Is Correlated With Elevation in Liver Function Tests in Patients With Symptomatic Choledocholithiasis  Ala I. Sharara, Nabil M. Mansour, Mustafa El–Hakam, Ola Ghaith, Mustapha El Halabi  Clinical Gastroenterology and Hepatology  Volume 8, Issue 12, Pages 1077-1082 (December 2010) DOI: 10.1016/j.cgh.2010.08.021 Copyright © 2010 AGA Institute Terms and Conditions

Figure 1 Percent distribution of ALT values (in IU/L) on presentation and upon repeat testing within the following 24 hours. Of the 40 patients, only those with minimally disturbed LFTs (n = 18) had repeat testing within 24 hours. Clinical Gastroenterology and Hepatology 2010 8, 1077-1082DOI: (10.1016/j.cgh.2010.08.021) Copyright © 2010 AGA Institute Terms and Conditions

Figure 2 The temporal relationship between onset of upper abdominal pain and LFTs (n = 40) for (A) alkaline phosphatase, (B) ALT, and (C) total bilirubin (n = 32). Clinical Gastroenterology and Hepatology 2010 8, 1077-1082DOI: (10.1016/j.cgh.2010.08.021) Copyright © 2010 AGA Institute Terms and Conditions

Figure 3 Serum ALT values over time in patients with intact gallbladder vs those with prior cholecystectomy. All values obtained during the initial 24 hours were included. Clinical Gastroenterology and Hepatology 2010 8, 1077-1082DOI: (10.1016/j.cgh.2010.08.021) Copyright © 2010 AGA Institute Terms and Conditions

Figure 4 Repeat LFTs in patients with normal or minimally disturbed values on presentation (n = 18). The figure depicts the rise in LFTs represented as the average fold-increase for each specific test between the initial blood draw in the Emergency Department and the repeat blood draw within 24 hours (*P < .05; **P < .01). Clinical Gastroenterology and Hepatology 2010 8, 1077-1082DOI: (10.1016/j.cgh.2010.08.021) Copyright © 2010 AGA Institute Terms and Conditions

Figure 5 Baseline () and repeat (•) serum ALT levels in the 18 patients with minimally disturbed LFTs on presentation. Clinical Gastroenterology and Hepatology 2010 8, 1077-1082DOI: (10.1016/j.cgh.2010.08.021) Copyright © 2010 AGA Institute Terms and Conditions

Figure 6 (A) Boyle's law regulating pressure-volume relationship of a fluid in a closed cylinder. The pressure created in the cylinder equals the force applied divided by the area of the piston (P = F/A) and (B) pressure dynamic model of a stone obstructing the biliary outflow at the sphincter choledochus, resulting in retrograde high amplitude phasic contractions. Clinical Gastroenterology and Hepatology 2010 8, 1077-1082DOI: (10.1016/j.cgh.2010.08.021) Copyright © 2010 AGA Institute Terms and Conditions