title: Hyperbilirubinemia without common bile duct abnormalities and hyperamylasemia without pancreatitis in patients with gallbladder disease.
abstract: OBJECTIVE
  To determine the incidence of jaundice and hyperamylasemia in the absence of common bile duct abnormalities or clinical pancreatitis in patients undergoing cholecystectomy.
  
  
  METHODS
  A continuous, prospective analysis of a consecutive case series was performed on all patients undergoing cholecystectomy.
  
  
  METHODS
  An urban, tertiary care university hospital.
  
  
  METHODS
  Adult patients with gallbladder disease.
  
  
  METHODS
  All patients underwent cholecystectomy.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Jaundice and hyperamylasemia can be produced by gallbladder disease alone.
authors.affiliation: Department of Surgery, St Louis University School of Medicine, Mo.
authors.forename: S M
authors.initials: SM
authors.lastname: Kurzweil
authors.forename: M J
authors.initials: MJ
authors.lastname: Shapiro
authors.forename: C H
authors.initials: CH
authors.lastname: Andrus
authors.forename: C M
authors.initials: CM
authors.lastname: Wittgen
authors.forename: V M
authors.initials: VM
authors.lastname: Herrmann
authors.forename: D L
authors.initials: DL
authors.lastname: Kaminski
mesh_terms: D000208:Acute Disease; D000328:Adult; D000681:Amylases / Q000097:blood*; D002763:Cholecystectomy; D002908:Chronic Disease; D005705:Gallbladder Diseases / Q000097:blood / Q000150:complications* / Q000601:surgery; D042882:Gallstones / Q000150:complications; D006801:Humans; D006932:Hyperbilirubinemia / Q000209:etiology*; D010195:Pancreatitis / Q000150:complications; D011446:Prospective Studies
chemical_list: D000681:Amylases