Related Experiment Videos
Hyperbilirubinemia without common bile duct abnormalities and hyperamylasemia without pancreatitis in patients with
S M Kurzweil1, M J Shapiro, C H Andrus
1Department of Surgery, St Louis University School of Medicine, Mo.
Objective:
To determine the incidence of jaundice and hyperamylasemia in the absence of common bile duct abnormalities or clinical pancreatitis in patients undergoing cholecystectomy.
Design:
A continuous, prospective analysis of a consecutive case series was performed on all patients undergoing cholecystectomy.
Setting:
An urban, tertiary care university hospital.
Patients:
Adult patients with gallbladder disease.
Intervention:
All patients underwent cholecystectomy.
Main Outcome Measures:
The presence or absence of common bile duct abnormalities was evaluated by cholangiography, and pancreatitis was identified by clinical signs, imaging studies, and direct visual inspection during cholecystectomy.
Results:
All patients (N = 1746) undergoing cholecystectomy were prospectively categorized as having chronic calculous (n = 1410), acute calculous (n = 217), chronic acalculous (n = 70), or acute acalculous (n = 49) gallbladder disease. It was uncommon for patients with chronic calculous cholecystitis to have an elevated bilirubin level with no choledocholithiasis and a normal common bile duct or to have hyperamylasemia without pancreatitis. Twenty-five percent of the patients with acute calculous cholecystitis had a serum bilirubin level between 34 and 86 mumol/L (2.0 and 5.0 mg/dL) with no common bile duct abnormality and 4% had hyperamylasemia without pancreatitis. Over one third of the patients with acute acalculous cholecystitis had an elevated bilirubin level with a normal common bile duct or an elevated amylase level without pancreatitis.
Conclusion:
Jaundice and hyperamylasemia can be produced by gallbladder disease alone.