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An elevated concentration of serum total [[bilirubin]] is diagnostic for jaundice. The upper limit of normal is >1 mg/dL or >1.3 mg/d in some laboratories. Hyperbilirubinemia can be further categorized as conjugated or unconjugated. Serum conjugated bilirubin concentration >0.4 mg/dL (6.8 micromol/L) revealed conjugated hyperbilirubinemia. In [[Unconjugated bilirubin|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).
An elevated concentration of serum total [[bilirubin]] is diagnostic for jaundice. The upper limit of normal is >1 mg/dL or >1.3 mg/d in some laboratories. Hyperbilirubinemia can be further categorized as conjugated or unconjugated. Serum conjugated bilirubin concentration >0.4 mg/dL (6.8 micromol/L) revealed conjugated hyperbilirubinemia. In [[Unconjugated bilirubin|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).


==Laboratory Findings==  
==Laboratory Findings==
* Laboratory findings consistent with the diagnosis of jaundice include:<ref name="pmid21250253">{{cite journal |vauthors=Walker HK, Hall WD, Hurst JW, Stillman AE |title= |journal= |volume= |issue= |pages= |year= |pmid=21250253 |doi= |url=}}</ref><ref name="pmid14765767">{{cite journal |vauthors=Roche SP, Kobos R |title=Jaundice in the adult patient |journal=Am Fam Physician |volume=69 |issue=2 |pages=299–304 |date=January 2004 |pmid=14765767 |doi= |url= |author=}}</ref>
Laboratory findings consistent with the diagnosis of jaundice include:<ref name="pmid21250253">{{cite journal |vauthors=Walker HK, Hall WD, Hurst JW, Stillman AE |title= |journal= |volume= |issue= |pages= |year= |pmid=21250253 |doi= |url=}}</ref><ref name="pmid14765767">{{cite journal |vauthors=Roche SP, Kobos R |title=Jaundice in the adult patient |journal=Am Fam Physician |volume=69 |issue=2 |pages=299–304 |date=January 2004 |pmid=14765767 |doi= |url= |author=}}</ref>
** An elevated concentration of serum total [[bilirubin]].
 
*** The upper limit of normal is >1 mg/dL or >1.3 mg/d in some laboratories. 
=== Elevated biliribin ===
*** Jaundice usually becomes clinically apparent when the serum total bilirubin concentration is greater than 2 to 3 mg/dL.  
* An elevated concentration of serum total [[bilirubin]] (Normal 0 - 1 mg/dL).
*** Threshold for clinically apparent jaundice may vary among patients. 


* Hyperbilirubinemia can be further categorized as conjugated or unconjugated:
* Hyperbilirubinemia can be further categorized as conjugated or unconjugated:
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*** Conjugated bilirubin is <1 mg/dL (17 micromol/L) if the total bilirubin is <5 mg/dL.
*** Conjugated bilirubin is <1 mg/dL (17 micromol/L) if the total bilirubin is <5 mg/dL.
*** Less than 20 percent of the total bilirubin if the total bilirubin is >5 mg/dL (85 micromol/L).
*** 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]].<ref name="pmid182153152">{{cite journal |vauthors=Kumagi T, Heathcote EJ |title=Primary biliary cirrhosis |journal=Orphanet J Rare Dis |volume=3 |issue= |pages=1 |year=2008 |pmid=18215315 |pmc=2266722 |doi=10.1186/1750-1172-3-1 |url=}}</ref>
=== Liver function tests ===
* Elevated [[lactate dehydrogenase]] is diagnostic for [[hemolysis]] as the underlying disease for jaundice.
* '''[[Alkaline phosphatase]]:'''
* Liver Function Tests:
** Elevated [[alkaline phosphatase]] may suggest the following as underlying cause of jaundice:<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
*** [[Pancreatic cancer|Pancreatic cance]]<nowiki/>r
*** [[Pancreatic cancer|Pancreatic cance]]<nowiki/>r
*** [[Pregnancy]]
*** [[Pregnancy]]
*** Drugs
*** Drugs
*** More rarely [[primary biliary cirrhosis]]
*** Rarely [[primary biliary cirrhosis]]
** Very high Serum transaminases may revealed [[viral hepatitis]] as the underlying disease.
* '''[[Transaminase|Liver transaminases]]'''
*** [[Aspartate aminotransferase]] (AST) is raised more than [[alanine aminotransferase]] (ALT) in [[cirrhosis]], intrahepatic [[neoplasia]], [[hemolytic]] 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>
** Very high serum [[transaminases]] may suggest [[viral hepatitis]] as the underlying disease.
*** ALT is raised more than AST in [[acute hepatitis]] and in extrahepatic obstruction.
** [[Aspartate aminotransferase]] (AST) is raised more in comparision to [[alanine aminotransferase]] (ALT) in the following conditions:<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>
** [[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>
*** [[cirrhosis]]
*** A raised [[mean corpuscular volume]] ([[MCV]]) with raised GGT may revealed alcohol abuse and, if accompanied by raised ALT, revealed [[liver]] cell damage as the underlying disease for jaundice.
*** intrahepatic [[neoplasia]]
*** Very high GGT levels (x 10 normal) may revealed [[Biliary obstruction]] and hepatic malignancies as the underlying disease for jaundice.
*** [[hemolytic]] jaundice
*** Raised GGT with raised alkaline phosphatase (more than 3 times) may revealed [[cholestasis]] as the underlying disease for jaundice.
*** [[alcoholic hepatitis]].
* Hepatitis serology:
** ALT is raised more in comparision to AST:
** For more information about hepatitis serology [[Viral hepatitis|click here]].
*** [[acute hepatitis]]
* Serum antinuclear antibodies (ANAs), [[anti-smooth muscle antibody]] (ASMA):
*** extrahepatic obstruction.
** Elevated [[antimitochondrial antibodies]] may revealed  [[primary biliary cirrhosis]](90-95% of patients).<ref name="pmid182153152">{{cite journal |vauthors=Kumagi T, Heathcote EJ |title=Primary biliary cirrhosis |journal=Orphanet J Rare Dis |volume=3 |issue= |pages=1 |year=2008 |pmid=18215315 |pmc=2266722 |doi=10.1186/1750-1172-3-1 |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>
** A raised [[mean corpuscular volume]] ([[MCV]]) with raised [[GGT]] may suggest alcohol abuse. If accompanied by raised ALT, it suggests [[liver]] cell damage as the underlying disease for jaundice.
** Very high [[GGT]] levels (x 10 normal) may suggest [[biliary obstruction]] and hepatic malignancies as the underlying disease for jaundice.
** Raised GGT with raised alkaline phosphatase (more than 3 times) may suggest [[cholestasis]] as the underlying disease for jaundice.
 
=== Complete blood count ===
* Decreased [[red blood cells]] and [[hemoglobin]] may suggest [[hemolysis]] as the underlying disease for jaundice.
 
=== Erythrocyte sedimentation rate ===
* [[Erythrocyte sedimentation rate]] may be elevated in [[primary biliary cirrhosis]] as the underlying disease for jaundice.<ref name="pmid182153152">{{cite journal |vauthors=Kumagi T, Heathcote EJ |title=Primary biliary cirrhosis |journal=Orphanet J Rare Dis |volume=3 |issue= |pages=1 |year=2008 |pmid=18215315 |pmc=2266722 |doi=10.1186/1750-1172-3-1 |url=}}</ref>
 
=== Lactate dehydrogenase levels ===
* Elevated [[lactate dehydrogenase]] is diagnostic of [[hemolysis]] as the underlying disease for jaundice.
 
=== Serology: ===
 
==== Hepatitis serology ====
* For more information about viral hepatitis serology [[Viral hepatitis|click here]].
 
==== Autoimmune antibodies ====
* '''Anti-nuclear antibodies (ANAs)'''
** [[Anti-nuclear antibody|Antinuclear antibody]] ([[ANA]]) may be raised in [[primary biliary cirrhosis]](20-30%).<ref name="pmid182153152" />
** [[Anti-nuclear antibody|Antinuclear antibody]] ([[ANA]]) may be raised in [[primary biliary cirrhosis]](20-30%).<ref name="pmid182153152" />
* Serum [[immunoglobulins]] and serum [[electrophoresis]] :
* '''Anti-smooth muscle antibody (ASMA):'''
** Elevated [[IgG]] may revealed [[acute hepatitis]] as the underlying disease for jaundice.<ref name="pmid21483590">{{cite journal |vauthors=Fallatah HI, Akbar HO |title=Elevated serum immunoglobulin G levels in patients with chronic liver disease in comparison to patients with autoimmune hepatitis |journal=Libyan J Med |volume=5 |issue= |pages= |date=January 2010 |pmid=21483590 |pmc=3071169 |doi=10.3402/ljm.v5i0.4857 |url= |author=}}</ref>
**
** Elevated [[IgM]] may revealed [[primary biliary cirrhosis]] as the underlying disease for jaundice.<ref name="pmid182153152">{{cite journal |vauthors=Kumagi T, Heathcote EJ |title=Primary biliary cirrhosis |journal=Orphanet J Rare Dis |volume=3 |issue= |pages=1 |year=2008 |pmid=18215315 |pmc=2266722 |doi=10.1186/1750-1172-3-1 |url=}}</ref>
* '''Anti-mitochondrial antibodies (AMA):'''
* [[Alpha 1-antitrypsin deficiency|Alpha-1-antitrypsin]] levels:
** Elevated [[antimitochondrial antibodies]] suggests [[primary biliary cirrhosis]] (90-95% of patients).<ref name="pmid182153152">{{cite journal |vauthors=Kumagi T, Heathcote EJ |title=Primary biliary cirrhosis |journal=Orphanet J Rare Dis |volume=3 |issue= |pages=1 |year=2008 |pmid=18215315 |pmc=2266722 |doi=10.1186/1750-1172-3-1 |url=}}</ref>
** Decreased alpha-1-antitrypsin may revealed [[cirrhosis]] as the underlying disease for jaundice.<ref name="pmid23355203">{{cite journal |vauthors=Greene DN, Elliott-Jelf MC, Straseski JA, Grenache DG |title=Facilitating the laboratory diagnosis of α1-antitrypsin deficiency |journal=Am. J. Clin. Pathol. |volume=139 |issue=2 |pages=184–91 |date=February 2013 |pmid=23355203 |doi=10.1309/AJCP6XBK8ULZXWFP |url= |author=}}</ref>
 
==== Serum electrophoresis ====
* Elevated [[IgG]] may suggest [[acute hepatitis]] as the underlying disease for jaundice.<ref name="pmid21483590">{{cite journal |vauthors=Fallatah HI, Akbar HO |title=Elevated serum immunoglobulin G levels in patients with chronic liver disease in comparison to patients with autoimmune hepatitis |journal=Libyan J Med |volume=5 |issue= |pages= |date=January 2010 |pmid=21483590 |pmc=3071169 |doi=10.3402/ljm.v5i0.4857 |url= |author=}}</ref>
* Elevated [[IgM]] may suggest [[primary biliary cirrhosis]] as the underlying disease for jaundice.<ref name="pmid182153152">{{cite journal |vauthors=Kumagi T, Heathcote EJ |title=Primary biliary cirrhosis |journal=Orphanet J Rare Dis |volume=3 |issue= |pages=1 |year=2008 |pmid=18215315 |pmc=2266722 |doi=10.1186/1750-1172-3-1 |url=}}</ref>
 
=== Enzyme levels ===


==== Alpha-1-antitrypsin levels: ====
* Decreased alpha-1-antitrypsin may suggests [[cirrhosis]] as the underlying disease for jaundice.<ref name="pmid23355203">{{cite journal |vauthors=Greene DN, Elliott-Jelf MC, Straseski JA, Grenache DG |title=Facilitating the laboratory diagnosis of α1-antitrypsin deficiency |journal=Am. J. Clin. Pathol. |volume=139 |issue=2 |pages=184–91 |date=February 2013 |pmid=23355203 |doi=10.1309/AJCP6XBK8ULZXWFP |url= |author=}}</ref>
==References==
==References==
{{reflist|2}}
{{reflist|2}}

Revision as of 17:56, 23 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

An elevated concentration of serum total bilirubin is diagnostic for jaundice. The upper limit of normal is >1 mg/dL or >1.3 mg/d in some laboratories. Hyperbilirubinemia can be further categorized as conjugated or unconjugated. Serum conjugated bilirubin concentration >0.4 mg/dL (6.8 micromol/L) revealed conjugated hyperbilirubinemia. In 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).

Laboratory Findings

Laboratory findings consistent with the diagnosis of jaundice include:[1][2]

Elevated biliribin

  • An elevated concentration of serum total bilirubin (Normal 0 - 1 mg/dL).
  • 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).
      • 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.
      • Less than 20 percent of the total bilirubin if the total bilirubin is >5 mg/dL (85 micromol/L).

Liver function tests

Complete blood count

Erythrocyte sedimentation rate

Lactate dehydrogenase levels

Serology:

Hepatitis serology

  • For more information about viral hepatitis serology click here.

Autoimmune antibodies

Serum electrophoresis

Enzyme levels

Alpha-1-antitrypsin levels:

  • Decreased alpha-1-antitrypsin may suggests cirrhosis as the underlying disease for jaundice.[9]

References

  1. ↑ Walker HK, Hall WD, Hurst JW, Stillman AE. PMID 21250253. Missing or empty |title= (help)
  2. ↑ Roche SP, Kobos R (January 2004). "Jaundice in the adult patient". Am Fam Physician. 69 (2): 299–304. PMID 14765767.
  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. ↑ 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.
  5. ↑ 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.
  6. ↑ Goldberg DM (1980). "Structural, functional, and clinical aspects of gamma-glutamyltransferase". CRC Crit Rev Clin Lab Sci. 12 (1): 1–58. PMID 6104563.
  7. ↑ 7.0 7.1 7.2 7.3 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.
  8. ↑ Fallatah HI, Akbar HO (January 2010). "Elevated serum immunoglobulin G levels in patients with chronic liver disease in comparison to patients with autoimmune hepatitis". Libyan J Med. 5. doi:10.3402/ljm.v5i0.4857. PMC 3071169. PMID 21483590.
  9. ↑ Greene DN, Elliott-Jelf MC, Straseski JA, Grenache DG (February 2013). "Facilitating the laboratory diagnosis of α1-antitrypsin deficiency". Am. J. Clin. Pathol. 139 (2): 184–91. doi:10.1309/AJCP6XBK8ULZXWFP. PMID 23355203.

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