Transaminase Levels in

SERUM transaminase levels have been reported to be elevated in pancreatitis, but the elevations are usually seen in icteric patients and probably reflect liver and biliary disease. The enzymes, serum glutamic oxaloacetic transaminase (SGOT) and serum glutamic pyruvic transaminase (SGPT), are found in various tissues. Wroblewski and LaDue1 established the levels of transaminase activity in homogenates of different human tissues and observed a level of concentration in the pancreas equal to 20% of that found in the liver. Diseases involving tissue containing these enzymes are thought to cause elevation of serum levels. On this basis, Foulk and Fleisher2 studied 32 patients during episodes of pancreatitis. Transaminase activity was increased in 22 of these patients. They concluded, however, that increased transaminase activity is not entirely dependent on pancreatic necrosis, but related to increased intrabiliary pressure and associated obstruction of the biliary tract. Weinstein et al3 further emphasized the factor of extrahepatic obstructive jaundice as a complication of pancreatitis. In their study of 24 chronic alcoholic patients with obstructive jaun¬ dice as a complication of pancreatitis, ten patients had common bile duct compression due to pan¬ creatitis or pancreatic pseudocyst demonstrated at surgical exploration or autopsy. The remaining 14 patients also were considered to have had com¬ pression of the common duct by pancreatitis on the basis of serum bilirubin and alkaline phosphatase levels compatible with obstructive jaundice. Transaminase levels were elevated in 17 out of 22 patients with one peak as high as 530 units; most were under 300 units. Transaminase levels, when elevated in obstruc¬ tive jaundice, are considered to reflect hepatocellular damage or impaired excretion by biliary ob¬ struction. Chinsky and Sherry4 found that normal human bile contained transaminase levels 100 times the serum level. They ligated the common ducts of rats and showed a rise in serum transaminase levels when compared with controls which had had sham operations without ligation. These changes in serum transaminase concentrations were not as¬ sociated with histological evidence of hepatic or cardiac necrosis. This experiment suggests that transaminase elevations in patients with obstruc¬ tive jaundice in the absence of hepatic necrosis may be based on an interference with normal ex¬ cretory mechanisms. The presence of normal trans¬ aminase values in some patients with obstructive jaundice indicates that other factors may be in¬ volved. In acute pancreatitis minimal transaminase level elevations may be due to pancreatic cellular necrosis. Patients with carcinoma of the pancreas without jaundice or liver metastases had normal values. Other factors many cause elevated transaminase levels in alcoholics with pancreatitis. These include underlying liver diseases such as nutritional cir¬ rhosis or hepatitis with cellular necrosis. Associated choledocholithiasis is also common and can result in obstructive jaundice. Opiates used for the relief of pain in pancreatitis have been shown to elevate the level of transaminase. This is probably related to increased pressure in the biliary tract and occurs more frequently in patients who have had a cholecystectomy. The gallbladder appears to act as a safety valve in regulating intraductal pressure. To further evaluate transaminase levels in pan¬ creatitis, the charts of patients hospitalized for pancreatitis within the last two years at the US Naval Hospital, Philadelphia, were reviewed for levels of transaminase and evidence of biliary ob¬ struction. Acute episodes of chronic relapsing pan¬ creatitis were diagnosed in a total of 37 patients,