scholarly journals The Predictivity of Serum Biochemical Markers in Acute Biliary Pancreatitis

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Bülent Güngör ◽  
Kasım Çağlayan ◽  
Cafer Polat ◽  
Deniz Şeren ◽  
Kenan Erzurumlu ◽  
...  
Keyword(s):  
Alkaline Phosphatase ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Biochemical Markers ◽  
Total Bilirubin ◽  
Direct Bilirubin ◽  
Gamma Glutamyl Transferase ◽  
Biliary Pancreatitis ◽  
Acute Biliary Pancreatitis ◽  
Glutamyl Transferase

Background and Aim. There are no accurate methods of differentiating acute biliary pancreatitis. Obstructions of biliary ducts, idiopathic pancreatitis may be related with biliary origin which needs identification for acute treatment. We searched for the predictivity of biochemical markers in early acute biliary pancreatitis. Patients and Methods. Serum levels of AST (Aspartate Transaminase),ALT (Alanine Transaminase), ALP (Alkaline Phosphatase), GGT (Gamma Glutamyl Transferase), total bilirubin, direct bilirubin, LDH (Lactate Dehydrogenase), amylase, lipase, CRP (C-Reactive Protein) and WBC (White Blood Cell) were measured in 157 patients with acute pancreatitis. Biliary and nonbiliary pancreatitis were differentiated by Magnetic Resonance Cholangiopancreatography (MRCP), Endoscopic Retrograde Cholangiopancreatography (ERCP), Intraoperative Cholangiopancreatography (IOC). Cut-off points of admission biochemical markers with sensitivity, specifity, positive predictive value and negative predictive value were determined after identification of significant variables. Receiver Operator Curves were plotted for each biochemical marker. Results. Serum Alkaline Phosphatase, total bilirubin, direct bilirubin, amylase and lipase levels were significantly higher in biliary pancreatitis with a positive predictive value of 80.8%, 83.9%, 81.6%, 78.8%, 79.7%. Conclusion. Increased Alkaline Phosphatase,total bilirubin, direct bilirubin, amylase and lipase levels may be used in prediction of biliary pancreatitis.

scholarly journals SAT-572 Extremely Elevated Plasma Lipoprotein X Level Secondary to Alcoholic Cholestasis

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Carolyn Ann Nelson ◽  
Zahid Ahmad ◽  
Abhimanyu Garg
Keyword(s):  
Alkaline Phosphatase ◽  
Alcohol Consumption ◽  
Total Bilirubin ◽  
Serum Lipoprotein ◽  
Plasma Lipoprotein ◽  
Direct Bilirubin ◽  
Serum Total Bilirubin ◽  
Gamma Glutamyl Transferase ◽  
Biliary Cirrhosis ◽  
Glutamyl Transferase

Abstract Background Marked elevations of plasma lipoprotein X (Lp-X) levels have been reported in patients with cholestasis due to primary biliary cirrhosis, pancreatic cancer, hepatitis C, and quetiapine. We now report a patient with extreme elevation of plasma Lp-X due to alcohol-induced cholestasis. Case Presentation A 44 year-old African American male presented with painless jaundice and fatigue for one week. He denied nausea, vomiting, diarrhea, change in stool or urine color, or weight loss. He consumes 720-1080 mL of beer (2-3 cans) every night and admitted to heavier alcohol consumption in the past. On physical examination he had scleral icterus and hepatomegaly but no xanthomas or xanthelasmas. His serum total cholesterol was 1,126 mg/dL (normal range, 120-199 mg/dL), triglycerides were 238 mg/dL (50-150 mg/dL), calculated LDL-cholesterol was 1,072 mg/dL (<100 mg/dL), and HDL-cholesterol was 6 mg/dL (>39 mg/dL). His serum AST, 162 IU/L (10-50 IU/L); ALT, 79 IU/L (10-50 IU/L); alkaline phosphatase, 1,058 IU/L (40-129 IU/L); total bilirubin, 18.8 mg/dL (0.2-1.3 mg/dL); direct bilirubin, 13.5 mg/dL (0-0.3 mg/dL); and gamma glutamyl transferase, 4,583 IU/L (8-61 IU/L) were markedly elevated. His blood alcohol level was 34 mg/dL (not detected), sodium 124 mmol/L (135-145 mmol/L), and platelet count was 84,000/µL (150,000-459,000/µL). His TSH 2.89 µIU/mL (0.4-4.5 µIU/mL), UA without proteinuria, HBV immunized, HCV negative, and anti-mitochondrial antibody negative. CT abdomen revealed hepatic steatosis and gallbladder swelling without evidence of obstruction. MRCP showed cirrhosis without primary sclerosing cholangitis. Serum lipoprotein electrophoresis confirmed the presence of Lp-X. On day 3 of hospitalization, his cholestasis improved and his serum total bilirubin 10.0 mg/dL, direct bilirubin 7.4 mg/dL, AST 108 IU/L, ALT 66 IU/L, and alkaline phosphatase 663 IU/L had improved. The patient was advised to abstain from all alcohol consumption. Telephone follow up 2 months later with his wife revealed that he had stopped drinking alcohol and that his jaundice had resolved. Conclusions Although alcohol-induced cholestasis is a well-recognized entity, such presentation with extreme elevations of Lp-X has not been previously reported. In such patients, it is important to establish whether extreme hypercholesterolemia is due to LDL or Lp-X since, as opposed to LDL, Lp-X elevations are not considered to be atherogenic.

scholarly journals Gangguan Fungsi Hati pada Coronavirus Disease 2019

2021 ◽  
Vol 2 (2) ◽  
Author(s):  
Tasha Salsabila ◽  
Bradley J. Waleleng ◽  
Karel Pandelaki
Keyword(s):  
Alkaline Phosphatase ◽  
Liver Function ◽  
Literature Review ◽  
Aspartate Aminotransferase ◽  
Alanine Aminotransferase ◽  
Total Bilirubin ◽  
Abnormal Liver Function ◽  
Gamma Glutamyl Transferase ◽  
Elevated Alkaline Phosphatase ◽  
Glutamyl Transferase

Abstract: The incidence and death rate of COVID-19 in North Sulawesi Province continues to increase and data regarding abnormal liver function in COVID-19 is not yet available. This study was aimed to obtain the liver function in COVID-19 patients. This was a literature review study using two databases, namely Pubmed and ClinicalKey. Keywords used were abnormal liver function AND COVID-19, elevated alanine aminotransferase AND COVID-19, elevated aspartate aminotransferase AND COVID-19, elevated gamma-glutamyl transferase AND COVID-19, elevated alkaline phosphatase AND COVID-19, elevated total bilirubin AND COVID-19. After being selected, 10 literatures were obtained based on inclusion and exclusion criteria. The results showed that increased liver function often occurred in cases of COVID-19, but the increase did not reach twice of the normal value. The most frequent increases were in GGT, followed by ALT and AST, total bilirubin, and the least was the increase in ALP. All literatures reported that increased liver function was more common in males, and in severe COVID-19 patients reported by eight literatures. Five literatures reported that elevated liver function increased mortality in COVID-19 cases. In conclusion, there are increases in ALT, AST, ALP, GGT, and total bilirubin levels in COVID-19 patients.Keywords: abnormal liver function, COVID-19 Abstrak: Angka kejadian dan angka kematian COVID-19 di Provinsi Sulawesi Utara terus bertambah sedangkan data mengenai gambaran gangguan fungsi hati pada COVID-19 belum tersedia. Penelitian ini bertujuan untuk mengetahui gambaran fungsi hati pada COVID-19. Jenis penelitian ialah literature review dengan pencarian data menggunakan dua database yaitu Pubmed dan ClinicalKey. Kata kunci yang digunakan yaitu abnormal liver function AND COVID-19, elevated alanine aminotransferase AND COVID-19, elevated aspartate aminotransferase AND COVID-19, elevated gamma-glutamyl transferase AND COVID-19, elevated alkaline phosphatase AND COVID-19, elevated total bilirubin AND COVID-19. Setelah diseleksi, didapatkan 10 literatur berdasarkan kriteria inklusi dan eksklusi. Penelitian ini mendapatkan bahwa peningkatan fungsi hati sering terjadi pada kasus COVID-19 namun peningkatannya tidak mencapai dua kali nilai normal. Peningkatan paling sering terjadi pada GGT, diikuti oleh ALT dan AST, bilirubin total, dan paling sedikit yaitu pada peningkatan ALP. Seluruh literatur melaporkan peningkatan fungsi hati lebih sering terjadi pada laki-laki dan pada kasus COVID-19 gejala berat dilaporkan oleh delapan literatur. Lima literatur melaporkan peningkatan fungsi hati meningkatkan mortalitas pada kasus COVID-19. Simpulan penelitian ini ialah, terdapat peningkatan kadar ALT, AST, ALP, GGT, dan bilirubin total pada penderita COVID-19.Kata kunci: gangguan fungsi Hati, COVID-19

Alkaline Phosphatase Isoenzyme Patterns in Malignant Disease

1992 ◽  
Vol 38 (12) ◽  
pp. 2546-2551 ◽  
Author(s):  
V O Van Hoof ◽  
A T Van Oosterom ◽  
L G Lepoutre ◽  
M E De Broe
Keyword(s):  
Alkaline Phosphatase ◽  
Liver Disease ◽  
Liver Metastasis ◽  
Bone Metastasis ◽  
Positive Predictive Value ◽  
Bone Disease ◽  
Predictive Value ◽  
Malignant Disease ◽  
Alp Activity ◽  
Isoenzyme Patterns

Abstract Early treatment of patients with malignant disease and liver or bone metastasis may increase their survival time. We have used the activity patterns of liver and bone isoenzymes of alkaline phosphatase (ALP), separated by agarose gel electrophoresis, to detect early metastasis. We studied ALP isoenzyme patterns in a background population of 101 patients with no evidence of any disease that might influence this pattern; a healthy reference population (n = 330); and the following three groups of patients: 143 with malignant disease, 47 with nonmalignant liver disease, and 22 with nonmalignant bone disease. Cutoff and predictive values of liver ALP, high-molecular-mass (high-M(r)) ALP, and bone ALP were established for detecting liver and bone metastasis. The positive predictive value of liver and high-M(r) ALP was higher than that of total ALP in detecting liver metastasis, but liver and high-M(r) ALP did not enable us to differentiate between malignant and nonmalignant liver disease. Total ALP activity was of slightly more value than liver and high-M(r) ALP in enabling us to rule out liver metastasis. From bone ALP activity we could not distinguish between nonmalignant bone disease and bone metastasis. The negative predictive value of bone ALP in the diagnosis of bone metastasis was low, but its positive predictive value was high and superior to that of total ALP.

scholarly journals A mini review on the Lactic Acidosis in goats and its remedial approaches

2020 ◽  
Vol 5 (2) ◽  
pp. 98-103
Author(s):  
Asad Ali Khaskheli ◽  
Muhammad Ibrahim Khaskheli ◽  
Allah Jurio Khaskheli ◽  
Arshad Ali Khaskheli
Keyword(s):  
Alkaline Phosphatase ◽  
Lactic Acidosis ◽  
Sodium Bicarbonate ◽  
Glucose Level ◽  
Magnesium Hydroxide ◽  
Total Bilirubin ◽  
Direct Bilirubin ◽  
Cassia Fistula ◽  
Indirect Bilirubin ◽  
Rumen Ph

The current study was performed in order to investigate the threat of lactic acidosis in goats worldwide and explore the curative strategies. In this regards a detailed review was performed, however obtained facts were found to be much interesting and valuable. It was indicated by researchers that lactic acidosis is the most common problem in goats throughout the worlds. It represents significant economic loss due to direct and indirect effects. It was further stated that goats with lactic acidosis show decreased body temperature up to 98.1±0.89 °F, rumen and intestinal movement 0.23±0.48/m, rumen pH 4.8±0.07, blood pH 7.1±0.08, increased respiration rate 56.14±7.15/m and heart rate, 136.28±4.71/m. Affected goats also show signs of dyspnea, anorexia, inactivity, incoordination and recumbancy. The glucose level remains 190.14±36.49 mg/dl, total bilirubin 0.75±0.04 mg/dl, direct bilirubin 0.27±0.03mg/dl, indirect bilirubin 0.40±0.03 mg/dl, alanine aminotransferase ALT 36.42±3.04 U/l and alkaline phosphatase 420±3.65 U/l. Furthermore, Glucose level, total bilirubin, direct bilirubin, indirect bilirubin, ALT (SGPT) and alkaline phosphatase increase with treatment of Cassia Fistula, serum biochemical changes rapidly return to normal compared to treatment with Sodium bicarbonate or Magnesium hydroxide. The ruminal juices changes are also significantly improved with the treatment. The changes in the ingesta color, odor and consistency and rumen pH return to normal with the use of Cassia Fistula, Sodium bicarbonate and Magnesium hydroxide. In conclusion, Cassia fistula, Sodium bicarbonate and Magnesium hydroxide could be used as valuable strategies against lactic acidosis in goats. These therapies have been proved to be effective for treating the acidosis in goats. 

Methods to reduce lipemic interference in clinical chemistry tests: a systematic review and recommendations

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Sheila X. Soh ◽  
Tze Ping Loh ◽  
Sunil K. Sethi ◽  
Lizhen Ong
Keyword(s):  
Systematic Review ◽  
High Speed ◽  
Total Bilirubin ◽  
Clinical Chemistry ◽  
Gamma Glutamyl Transferase ◽  
Pooled Data ◽  
Pubmed Search ◽  
Glutamyl Transferase ◽  
Study Designs ◽  
Clinical Chemistry Tests

Abstract Objectives Lipemia is the presence of abnormally high lipoprotein concentrations in serum or plasma samples that can interfere with laboratory testing. There is little guidance available from manufacturers or professional bodies on processing lipemic samples to produce clinically acceptable results. This systematic review summarizes existing literature on the effectiveness of lipid removal techniques in reducing interference in clinical chemistry tests. Methods A PubMed search using terms relating to lipid removal from human samples for clinical chemistry tests produced 1,558 studies published between January 2010 and July 2021. 15 articles met the criteria for further analyses. Results A total of 66 analytes were investigated amongst the 15 studies, which showed highly heterogenous study designs. High-speed centrifugation was consistently effective for 13 analytes: albumin, alkaline phosphatase (ALP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, creatine kinase (CK), creatinine (Jaffe method), gamma-glutamyl transferase (GGT), glucose (hexokinase-based method), lactate dehydrogenase (LDH), phosphate, potassium, and urea. Lipid-clearing agents were uniformly effective for seven analytes: ALT, AST, total bilirubin, CK, creatinine (Jaffe method), lipase, and urea. Mixed results were reported for the remaining analytes. Conclusions For some analytes, high-speed centrifugation and/or lipid-clearing agents can be used in place of ultracentrifugation. Harmonized protocols and acceptability criteria are required to allow pooled data analysis and interpretation of different lipemic interference studies.

Quantitative fractionation of alkaline phosphatase isoenzymes according to their thermostability.

1976 ◽  
Vol 22 (1) ◽  
pp. 42-48 ◽  
Author(s):  
C PetitClerc
Keyword(s):  
Alkaline Phosphatase ◽  
Liver Disease ◽  
Phosphatase Activity ◽  
Alkaline Phosphatase Activity ◽  
Normal Serum ◽  
Transferase Activity ◽  
Gamma Glutamyl Transferase ◽  
Heat Labile ◽  
Alkaline Phosphatase Isoenzymes ◽  
Glutamyl Transferase

Abstract Continuous monitoring of heat denaturation of a mixture of alkaline phosphatase isoenzymes at 60 degrees C and pH 7.5 permits the simultaneous direct identification and quantitation of three isoenzymes: the placental isoenzyme, the L-phenylalanine-sensitive intestinal isoenzyme, and the liver isoenzyme (hepatocytic). The isoenzyme that is principally of bone origin cannot be identified as such without the help of other diagnostic aids and the patient's medical history. All human tissues contain alkaline phosphatase, many organs more than one of the isoenzymes. Liver alkaline phosphatase, which constitutes 40-50% of normal serum alkaline phosphatase activity, was measured in the serum of persons with various liver diseases. Its activity exceeded normal in all types of liver disease; in 80% of cases this increase was accompanied by increased gamma-glutamyl-transferase activity, but the quantitative correlationship (r = 0.54) was not as good as expected if both enzymes come from the same source and are indices of liver dieases. Liver alkaline phosphatase activity increases in the blood early in liver disease, before most liver tests show abnormalities. The other major isoenzyme of normal serum probably represents a mixture of isoenzymes from bone and reticulo-endothelial and vascular tissues, which all contain the same "very heat-labile" alkaline phosphatase. Cord blood and children's sera contain mostly this very heat-labile isoenzyme.

Interference in an automated radial partition fluorescent immunoassay of thyrotropin associated with liver-function abnormalities

1990 ◽  
Vol 36 (7) ◽  
pp. 1343-1345 ◽  
Author(s):  
D B Sacks ◽  
M M Lim ◽  
C A Parvin ◽  
G Kessler
Keyword(s):  
Alkaline Phosphatase ◽  
Liver Function ◽  
Biochemical Markers ◽  
Total Bilirubin ◽  
Regression Line ◽  
Positive Bias ◽  
Gamma Glutamyltransferase ◽  
Residual Variability

Abstract In a previous evaluation of a "sensitive" radial partition fluorescent immunoassay on the Stratus system, thyrotropin (TSH) values exhibited a positive bias in icteric samples when compared with results of a nonsensitive radioimmunoassay. In the present study, we evaluated 366 patients samples to assess whether any biochemical markers of liver function could identify samples for which TSH values would be falsely increased. gamma-Glutamyltransferase and total bilirubin concentrations were unrelated to discrepant TSH values. In contrast, alkaline phosphatase (ALP) was significantly positively correlated with differences in Stratus and RIA TSH concentrations (P less than 0.001). However, this correlation explained only 34% of the observed residual variability around the estimated regression line. On average, the higher ALP values were associated with larger discrepancies between Stratus and RIA TSH values, although several samples with increased ALP did not have falsely increased Stratus TSH values. TSH measurements performed with a Stratus should be interpreted with caution in patients with abnormal biochemical markers of liver function.

scholarly journals Predictor factors for choledocholithiasis

2015 ◽  
Vol 28 (2) ◽  
pp. 109-112 ◽  
Author(s):  
Joana TOZATTI ◽  
André Luiz Parizi MELLO ◽  
Orli FRAZON
Keyword(s):  
Alkaline Phosphatase ◽  
Statistical Significance ◽  
Magnetic Resonance Cholangiopancreatography ◽  
High Specificity ◽  
Control Group ◽  
Interventional Treatment ◽  
Gamma Glutamyl Transferase ◽  
Imaging Studies ◽  
Laboratory Markers ◽  
Glutamyl Transferase

BACKGROUND: The choledocolithiasis has an incidence of 8-20% in patients with cholecystolithiasis. The preoperative diagnosis guides the interventional treatment on the bile duct AIM: To evaluate the sensitivity and specificity of the laboratory markers and imaging studies for choledocholithiasis preoperatively. METHODS: The study comprised 254 patients divided into two groups: the control group (207 patients), patients without choledocholithiasis intraoperatively and cases group (47 patients), that enrolled the patients with choledocholithiasis intra-operatively. Were evaluated the laboratory markers, image exams and intra-operative diagnostic aspects. RESULTS: The sample was homogeneous for age and gender. It was observed that 47% of the cases the patients did not show comorbidities. Hospitalization showes in cases group acute pancreatitis in12.8%, jaundice in 30%, fever in 30% and pain in the right hypochondrium in 95%. By comparing them, was observed that fever and jaundice were the signs and symptoms with statistical significance. Patients with choledocholithiasis had transaminases, alkaline phosphatase, gamma-glutamyl transferase and higher bilirubin with statistical significance (p<0.001). In regard to imaging studies, ultrasound was fairly accurate for cholelithiasis and choledocholithiasis (p<0.001). CONCLUSION: Changes in canalicular and transaminase enzymes are suggestive for preoperative choledocholithiasis; GGT showed better sensitivity and alkaline phosphatase greater specificity; ultrasonography and nuclear magnetic resonance cholangiopancreatography showed high specificity.

scholarly journals Evaluation of Serum Zinc Status and Serum Alkaline Phosphatase Activity in Alcoholic Liver Disease Patients - A Hospital Based Study from Chennai, Tamil Nadu

2021 ◽  
Vol 8 (24) ◽  
pp. 2100-2105
Author(s):  
Uma T ◽  
Nirmaladevi P ◽  
Shanthi R ◽  
Mahalakshmi R
Keyword(s):  
Alkaline Phosphatase ◽  
Liver Disease ◽  
Phosphatase Activity ◽  
Alcoholic Liver Disease ◽  
Alkaline Phosphatase Activity ◽  
Serum Zinc ◽  
Meld Score ◽  
Gamma Glutamyl Transferase ◽  
Zinc Status ◽  
Glutamyl Transferase

BACKGROUND Alcoholism remains to be the major cause of morbidity and mortality throughout the world. Consuming alcohol is the potent etiological factor for the development of alcoholic liver diseases (ALD), ranging from fatty liver to hepatocellular carcinoma with varying rates of development in both genders depending on the quality, quantity, and duration of the drink. Zinc deficiency has been documented with the progression of alcoholic liver disease. It is also a well-known fact that zinc is a co-factor for enzyme alkaline phosphatase. This study aims to assess the zinc status and alkaline phosphatase activity in patients with various stages of alcoholic liver disease, correlate zinc with alkaline phosphatase activity, albumin, gamma glutamyl transferase activity, MELD score and duration of alcohol intake and analysing the need for evaluating zinc in these patients. METHODS This comparative observational study involves group I healthy controls and group II patients diagnosed to have ethanol related decompensated liver disease with or without portal hypertension for more than three years from the Department of Medical Gastroenterology, Government Medical College Hospital. 5 ml of venous blood in fasting state was collected from both groups and assayed for serum zinc, and serum alkaline phosphatase activity. The data was statistically analysed. RESULTS The study results demonstrate that higher percentage of patients with alcoholic liver disease have low serum zinc levels than healthy controls. Zinc when compared with variables like serum albumin, duration of alcohol intake, MELD score, serum gamma glutamyl transferase and alkaline phosphatase in the case and control groups were found to be statistically significant. CONCLUSIONS There is decrease in serum zinc level and increased alkaline phosphatase activity in patients with alcoholic liver disease. The statistically significant data is a strong rationale for evaluating the zinc status and thereby supplementing zinc to patients with alcoholic liver disease. KEYWORDS Alcoholic Liver Disease, Zinc, Alkaline Phosphatase, MELD Score

scholarly journals Comparative Study of Serum Gamma Glutamyltransferase, 5’ Nucleotidase and Alkaline Phosphatase in Icteric and an-Icteric Biliary Disease Patients

2013 ◽  
Vol 12 (1) ◽  
Author(s):  
Dr. Maninder Pal Singh Gill
Keyword(s):  
Alkaline Phosphatase ◽  
Significant Rise ◽  
Control Group ◽  
P Value ◽  
Gamma Glutamyl Transferase ◽  
Biliary Disease ◽  
Gamma Glutamyl ◽  
Hepatobiliary Diseases ◽  
Glutamyl Transferase ◽  
Diagnostic Indicator

Introduction: Diagnostic enzymology plays a useful role in evaluation of various hepatobiliary diseases and numerous enzymes have been compared in different disorders. Among these, significance of Gamma Glutamyl Transferase and 5’ Nucleotidase over Alkaline Phosphatase has been stressed repeatedly, but mainly in the icteric obstructive biliary disease patients. In this study, these three enzymes were compared not only in the icteric but also the an-icteric biliary disease patients, particularly to look for elevation and significance of these enzymes in the latter group.Methods: The study was conducted on 50 biliary disease patients, who were further divided into an-icteric (32 patients) and icteric (18 patients) subgroups depending on their bilirubin levels. 50 subjects matched for age and sex with the study group were enrolled for the control group. Gamma Glutamyl Transferase, 5’Nucleotidase, Alkaline Phosphatase and bilirubin levels were evaluated in all the patients as well as the control subjects. Results: All three enzymes showed a significant rise in the icteric subgroup (p value < 0.001). However, in the an-icteric subgroup, only Gamma Glutamyl Transferase and 5’Nucleotidase showed a significant rise. The rise was more for Gamma Glutamyl Transferse (1.60 times normal, p < 0.001) as compared to 5’Nucleotidase (1.39 times normal, p < 0.01). Conclusion: Gamma Glutamyl Transferase and 5’Nucleotidase are useful for evaluation of not only obstructive biliary disease patients but also for the patients with biliary disease who are an-icteric, and out of these two, the former is a more valuable diagnostic indicator in such diseases

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