RECOGNITION OF BILIARY TRACT OBSTRUCTION WITHOUT JAUNDICE

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Abstract
Obstructive jaundice and the use of liver function tests for it's diagnosis are widely understood. Biliary tract obstruction in the absence of jaundice, however, is rarely recognized or even thought of, even though it is of relatively common occurrence and can be detected frequently by the application of appropriate liver function tests. The identification of obstructive jaundice depends on the presence of an increased level of directacting bilirubin in the serum or bilirubinuria and abnormal results in tests of biliary tract patency, that is, an elevated serum alkaline phosphatase level and/or cholesterol in the presence of tests of normal parenchymal function, such as the cephalin-cholesterol flocculation and thymol turbidity tests. Partial obstruction of the biliary tract may produce the same pattern of liver function tests, even though the serum bilirubin level is not elevated. In addition, the sulfobromophthalein test, which in the presence of jaundice provides no further information, may

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