Jaundice laboratory findings: Difference between revisions
Jump to navigation
Jump to search
| Line 26: | Line 26: | ||
*** More rarely, [[PBC]] | *** More rarely, [[PBC]] | ||
** Very high Serum transaminases may revealed [[viral hepatitis]] as the underlying disease. | ** 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]].<ref name="pmid10781624">{{cite journal |vauthors=Pratt DS, Kaplan MM |title=Evaluation of abnormal liver-enzyme results in asymptomatic patients |journal=N. Engl. J. Med. |volume=342 |issue=17 |pages=1266–71 |year=2000 |pmid=10781624 |doi=10.1056/NEJM200004273421707 |url=}}</ref> | ||
*** 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. | ||
** [[Gamma-glutamyltransferase]] (GGT):<ref name="pmid696683">{{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><ref name="pmid6104563">{{cite journal |vauthors=Goldberg DM |title=Structural, functional, and clinical aspects of gamma-glutamyltransferase |journal=CRC Crit Rev Clin Lab Sci |volume=12 |issue=1 |pages=1–58 |year=1980 |pmid=6104563 |doi= |url=}}</ref> | ** [[Gamma-glutamyltransferase]] (GGT):<ref name="pmid696683">{{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><ref name="pmid6104563">{{cite journal |vauthors=Goldberg DM |title=Structural, functional, and clinical aspects of gamma-glutamyltransferase |journal=CRC Crit Rev Clin Lab Sci |volume=12 |issue=1 |pages=1–58 |year=1980 |pmid=6104563 |doi= |url=}}</ref> | ||
Revision as of 14:25, 6 February 2018
|
Jaundice Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Jaundice laboratory findings On the Web |
|
American Roentgen Ray Society Images of Jaundice laboratory findings |
|
Risk calculators and risk factors for Jaundice laboratory findings |
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).
- Conjugated hyperbilirubinemia:
- Decreased RBC and HGB may revealed haemolysis as the underlying disease for jaundice.
- Erythrocyte sedimentation rate may be rise in primary biliary cirrhosis.[2]
- 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:[3]
- Gallstones causing bile duct obstruction
- Pancreatic cancer
- Pregnancy
- Drugs
- More rarely, PBC
- 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.[4]
- ALT is raised more than AST in acute hepatitis and in extrahepatic obstruction.
- Gamma-glutamyltransferase (GGT):[5][6]
- A raised MCV with raised GGT may revealed alcohol abuse and, if accompanied by raised ALT, revealed liver cell damage as the underlying disease for jaundice.
- Very high GGT levels (x 10 normal) may revealed Biliary obstruction and hepatic malignancies as the underlying disease for jaundice.
- Raised GGT with raised alkaline phosphatase (over x 3 normal) may revealed cholestasis as the underlying disease for jaundice.
- Alkaline phosphatase: Elevated alkaline phosphatase may reflect the followings:[3]
- Hepatitis serology:
- screen for viral hepatitis.[7]
- Serum antinuclear antibodies (ANAs), anti-smooth muscle antibody (ASMA):
- Elevated antimitochondrial antibodies may revealed PBC.(90-95% of patients )[2]
- ANA is positive in 20-50% of patients with PBC.
- Serum immunoglobulins and serum electrophoresis :
- Elevated IgG may revealed acute hepatitis as the underlying disease for jaundice.
- Elevated IgM may revealed PBC as the underlying disease for jaundice.[2]
- Alpha-1-antitrypsin levels:
- Decrease alpha-1-antitrypsin may revealed cirrhosis as the underlying disease for jaundice.
References
- ↑ Walker HK, Hall WD, Hurst JW, Stillman AE. PMID 21250253. Missing or empty
|title=(help) - ↑ 2.0 2.1 2.2 Kumagi T, Heathcote EJ (2008). "Primary biliary cirrhosis". Orphanet J Rare Dis. 3: 1. doi:10.1186/1750-1172-3-1. PMC 2266722. PMID 18215315.
- ↑ 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.
- ↑ Pratt DS, Kaplan MM (2000). "Evaluation of abnormal liver-enzyme results in asymptomatic patients". N. Engl. J. Med. 342 (17): 1266–71. doi:10.1056/NEJM200004273421707. PMID 10781624.
- ↑ 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.
- ↑ Goldberg DM (1980). "Structural, functional, and clinical aspects of gamma-glutamyltransferase". CRC Crit Rev Clin Lab Sci. 12 (1): 1–58. PMID 6104563.
- ↑ Fields, Bernard (2007). Fields virology. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN 0781760607.