Jaundice laboratory findings: Difference between revisions

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* [[Erythrocyte sedimentation rate]] may be rise in [[primary biliary cirrhosis]].
* [[Erythrocyte sedimentation rate]] may be rise in [[primary biliary cirrhosis]].
* Elevated lactate dehydrogenase is diagnostic for hemolysis as the underlying disease for jaundice.
* Elevated lactate dehydrogenase is diagnostic for hemolysis as the underlying disease for jaundice.
* LFTs:
* Liver Function Tests:
** [[Alkaline phosphatase]]: Elevated alkaline phosphatase may reflect the followings:<ref name="pmid6966832">{{cite journal |vauthors=Ellis G, Goldberg DM, Spooner RJ, Ward AM |title=Serum enzyme tests in diseases of the liver and biliary tree |journal=Am. J. Clin. Pathol. |volume=70 |issue=2 |pages=248–58 |year=1978 |pmid=696683 |doi= |url=}}</ref>
** [[Alkaline phosphatase]]: Elevated alkaline phosphatase may reflect the followings:<ref name="pmid6966832">{{cite journal |vauthors=Ellis G, Goldberg DM, Spooner RJ, Ward AM |title=Serum enzyme tests in diseases of the liver and biliary tree |journal=Am. J. Clin. Pathol. |volume=70 |issue=2 |pages=248–58 |year=1978 |pmid=696683 |doi= |url=}}</ref>
*** [[Gallstones]] causing bile duct obstruction
*** [[Gallstones]] causing bile duct obstruction
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*** Drugs
*** Drugs
*** More rarely, [[PBC]]
*** More rarely, [[PBC]]
** Serum transaminases are usually very high in [[viral hepatitis]].
** Very high Serum transaminases may revealed [[viral hepatitis]] as the underlying disease.
*** Aspartate aminotransferase (AST) is raised more than alanine aminotransferase (ALT) in [[cirrhosis]], intrahepatic [[neoplasia]], haemolytic jaundice and [[alcoholic hepatitis]].
*** Aspartate aminotransferase (AST) is raised more than alanine aminotransferase (ALT) in [[cirrhosis]], intrahepatic [[neoplasia]], haemolytic jaundice and [[alcoholic hepatitis]].
*** ALT is raised more than AST in acute hepatitis and in extrahepatic obstruction.
*** ALT is raised more than AST in acute hepatitis and in extrahepatic obstruction.
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*** A raised MCV with raised GGT suggests alcohol abuse and, if accompanied by raised ALT, suggests liver cell damage.
*** A raised MCV with raised GGT suggests alcohol abuse and, if accompanied by raised ALT, suggests liver cell damage.
*** Very high GGT levels (x 10 normal) suggests Biliary obstruction and hepatic malignancies.
*** Very high GGT levels (x 10 normal) suggests Biliary obstruction and hepatic malignancies.
*** Raised GGT with raised alkaline phosphatase (over x 3 normal) suggests [[cholestasis]].
*** Raised GGT with raised alkaline phosphatase (over x 3 normal) may revealed [[cholestasis]] as the underlying disease for jaundice.
* Hepatitis serology:
* Hepatitis serology:
** screen for [[viral hepatitis]].<ref>{{cite book | last = Fields | first = Bernard | title = Fields virology | publisher = Wolters Kluwer Health/Lippincott Williams & Wilkins | location = Philadelphia | year = 2007 | isbn = 0781760607 }}</ref>
** screen for [[viral hepatitis]].<ref>{{cite book | last = Fields | first = Bernard | title = Fields virology | publisher = Wolters Kluwer Health/Lippincott Williams & Wilkins | location = Philadelphia | year = 2007 | isbn = 0781760607 }}</ref>
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** [[ANA]] is positive in 20-50% of patients with PBC.
** [[ANA]] is positive in 20-50% of patients with PBC.
* Serum [[immunoglobulins]] and serum [[electrophoresis]] :
* Serum [[immunoglobulins]] and serum [[electrophoresis]] :
** IgG is raised in [[acute hepatitis]]
** Elevated IgG may revealed [[acute hepatitis]] as the underlying disease for jaundice.
** IgM is raised in [[autoimmune disease]], [[PBC]] or chronic infection.
** Elevated IgM may revealed  [[autoimmune disease]], [[PBC]].
* [[Alpha 1-antitrypsin deficiency|Alpha-1-antitrypsin]] levels:
* [[Alpha 1-antitrypsin deficiency|Alpha-1-antitrypsin]] levels:
** deficiency causes [[cirrhosis]]
** deficiency causes [[cirrhosis]]

Revision as of 14:09, 6 February 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Farnaz Khalighinejad, MD [2]

Overview

Laboratory Findings

  • Laboratory findings consistent with the diagnosis of jaundice include:[1]
    • An elevated concentration of serum total bilirubin. The upper limit of normal is >1 mg/dL or >1.3 mg/d in some laboratories.
    • Jaundice usually becomes clinically apparent when the serum total bilirubin concentration is greater than 2 to 3 mg/dL , but threshold for clinically apparent jaundice may vary among patients.
  • Hyperbilirubinemia can be further categorized as conjugated or unconjugated:
    • Conjugated hyperbilirubinemia:
      • Serum conjugated bilirubin concentration >0.4 mg/dL (6.8 micromol/L).
      • Direct bilirubin >1 mg/dL (17 micromol/L) if the total bilirubin is <5 mg/dL (85 micromol/L), or more than 20 percent of the total bilirubin if the total bilirubin is >5 mg/dL (85 micromol/L).
    • Unconjugated hyperbilirubinemia:
      •  Conjugated bilirubin is <1 mg/dL (17 micromol/L) if the total bilirubin is <5 mg/dL, or less than 20 percent of the total bilirubin if the total bilirubin is >5 mg/dL (85 micromol/L).
  • Decreased RBC and HGB may revealed haemolysis as the underlying disease for jaundice.
  • Erythrocyte sedimentation rate may be rise in primary biliary cirrhosis.
  • Elevated lactate dehydrogenase is diagnostic for hemolysis as the underlying disease for jaundice.
  • Liver Function Tests:
    • Alkaline phosphatase: Elevated alkaline phosphatase may reflect the followings:[2]
    • Very high Serum transaminases may revealed viral hepatitis as the underlying disease.
      • Aspartate aminotransferase (AST) is raised more than alanine aminotransferase (ALT) in cirrhosis, intrahepatic neoplasia, haemolytic jaundice and alcoholic hepatitis.
      • ALT is raised more than AST in acute hepatitis and in extrahepatic obstruction.
    • Gamma-glutamyltransferase (GGT):[3][4]
      • A raised MCV with raised GGT suggests alcohol abuse and, if accompanied by raised ALT, suggests liver cell damage.
      • Very high GGT levels (x 10 normal) suggests Biliary obstruction and hepatic malignancies.
      • Raised GGT with raised alkaline phosphatase (over x 3 normal) may revealed cholestasis as the underlying disease for jaundice.
  • Hepatitis serology:
  • Serum antinuclear antibodies (ANAs), anti-smooth muscle antibody (ASMA):
  • Serum immunoglobulins and serum electrophoresis :
  • Alpha-1-antitrypsin levels:

References

  1. Walker HK, Hall WD, Hurst JW, Stillman AE. PMID 21250253. Missing or empty |title= (help)
  2. Ellis G, Goldberg DM, Spooner RJ, Ward AM (1978). "Serum enzyme tests in diseases of the liver and biliary tree". Am. J. Clin. Pathol. 70 (2): 248–58. PMID 696683.
  3. Ellis G, Goldberg DM, Spooner RJ, Ward AM (1978). "Serum enzyme tests in diseases of the liver and biliary tree". Am. J. Clin. Pathol. 70 (2): 248–58. PMID 696683.
  4. Goldberg DM (1980). "Structural, functional, and clinical aspects of gamma-glutamyltransferase". CRC Crit Rev Clin Lab Sci. 12 (1): 1–58. PMID 6104563.
  5. Fields, Bernard (2007). Fields virology. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN 0781760607.

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