The National Institute of Diabetes and Digestive and Kidney Diseases notes that biliary cholesterol is responsible for 80 percent of gallstones. Gallstones may cause cholecystitis or inflammation of the gallbladder which can result in severe abdominal pain, nausea, vomiting and elevated liver enzymes. If these attacks occur frequently then you may need to have your gallbladder removed, a procedure known as a cholecystectomy. Occasionally even after your gallbladder is removed, abdominal pain and elevated enzymes remain.
Liver Enzymes
The transaminases, ALT and AST are measurements of liver function. Elevated liver enzymes are an indication of inflammation or injury to the cells of the liver. When the liver cells are damaged, they leak these enzymes into the bloodstream. Many reasons for elevated liver enzymes exist, including alcoholism, hepatitis, obesity, celiac disease and cirrhosis. When elevated liver enzymes present after cholecystectomy it is possible that an injury has occurred.
Common Bile Duct Injury
According to the University of Southern California Department of Surgery, the most common cause of bile duct injury is trauma during laparoscopic gallbladder surgery. Approximately 0.1 to 1 percent of gallbladder surgeries lead to this complication. Patients with bile duct injury present with persistent pain. discomfort and increased liver enzymes after surgery. Some will go on to develop fever and jaundice. Bile duct injuries can lead to bile leakage into the abdominal cavity resulting in an infection of the abdominal cavity. Patients with bile duct injuries need treatment in a specialized center that has experience treating this type of injury.
Hepatic Artery Injury
Inadvertent hepatic artery injury can also occur during laparoscopic cholecystectomy with resulting pain and elevated liver enzymes. According to a 2008 British Journal of Surgery article, hepatic artery injury carries a high mortality rate. It may be possible to reconstruct the hepatic artery but this is complicated surgery. Liver necrosis may occur with this type of injury.
Retained Gallbladder Stones
The most common cause of pain and elevated liver enzymes after gallbladder surgery is retained gallbladder stones blocking the duct. According to the Merck Manual Online Library, up to 10 percent of patients with symptomatic gallstones have associated common bile duct stones. Obstructed ducts cause biliary pain and, if left untreated, may cause jaundice and possibly gallstone pancreatitis.
