Jaundice laboratory findings: Difference between revisions

Jump to navigation Jump to search
m (Kalsang Dolma moved page Jaundice lab tests to Jaundice laboratory findings)
m (Bot: Removing from Primary care)
 
(53 intermediate revisions by 6 users not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
{{Jaundice}}
{{Jaundice}}
{{CMG}}; {{AE}}{{FKH}}


{{CMG}}
==Overview==
==Lab Findings==  
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).
* Total and unconjugated [[Bilirubin]]
** [[Bilirubin]] is the major breakdown product of hemoglobin that is released from dying or damaged erythrocytes
** The normal [[Bilirubin]] range is 0.3-1.0 mg/dL
* [[Aspartate transaminase]](AST) (or) SGOT
* [[Alanine transaminase]](ALT) (or) SGPT
* [[Albumin]]
* [[Alkaline phosphatase]]
* [[HIV]] serologies
* [[Hepatitis]] serologies
* [[Antinuclear antibody]] (ANA)
* [[Antimitochondrial antibodies]]
* [[Haptoglobin]]
* [[Reticulocyte count]]
* [[Leukocytosis]]
* [[Lactic dehydrogenase]] (LDH)


Inalcoholic hepatitis the aspartate aminotransferase:alanine aminotransferase ratio is > 2 (AST:ALT)
==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>


=== Elevated biliribin ===
* An elevated concentration of serum total [[bilirubin]] (Normal 0 - 1 mg/dL).
* Hyperbilirubinemia can be further categorized as conjugated or unconjugated:
** [[Conjugated bilirubin|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 bilirubin|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 ===
* '''[[Alkaline phosphatase]]:'''
** 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>
*** [[Gallstones]] causing bile duct obstruction
*** [[Pancreatic cancer|Pancreatic cance]]<nowiki/>r
*** [[Pregnancy]]
*** Drugs
*** Rarely [[primary biliary cirrhosis]]
* '''[[Transaminase|Liver transaminases]]'''
** Very high serum [[transaminases]] may suggest [[viral hepatitis]] as the underlying disease.<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>
** Most causes of liver cell injury are associated with a greater increase in ALT than AST.
** AST to ALT ratio of 2:1 or greater is suggestive of alcoholic liver disease.
* '''[[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-smooth muscle antibody (ASMA):'''
** [[Anti-smooth muscle antibodies|Anti-smooth muscle antibodie]]<nowiki/>s are [[Antibody|antibodies]] ([[Immunoglobulin|immunoglobulins]]) formed against [[smooth muscle]]. These antibodies are typically associated with [[autoimmune hepatitis]].<ref name="pmid1589647">{{cite journal |vauthors=Tomizawa Y, Noishiki Y, Okoshi T, Koyanagi H |title=[A rabbit model for evaluation of a small-caliber vascular graft] |language=Japanese |journal=Kokyu To Junkan |volume=40 |issue=5 |pages=481–4 |date=May 1992 |pmid=1589647 |doi= |url=}}</ref>
* '''Anti-mitochondrial antibodies (AMA):'''
** 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>
==== 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}}
[[Category:primary care]]
{{WH}}
[[Category:Disease]]
{{WS}}
[[Category:Digestive system]]
 
[[Category:Gastroenterology]]
[[Category:Gastroenterology]]
[[Category:Hepatology]]
[[Category:Hepatology]]
[[Category:Signs and symptoms]]
[[Category:Needs overview]]
[[Category:Needs overview]]
{{WH}}
{{WS}}

Latest revision as of 22:27, 29 July 2020

Jaundice Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Jaundice from other Conditions

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Chest X Ray

Electrocardiogram

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Jaundice laboratory findings On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Jaundice laboratory findings

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Jaundice laboratory findings

CDC on Jaundice laboratory findings

Jaundice laboratory findings in the news

Blogs on Jaundice laboratory findings

Directions to Hospitals Treating Jaundice

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

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.[10]

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. Tomizawa Y, Noishiki Y, Okoshi T, Koyanagi H (May 1992). "[A rabbit model for evaluation of a small-caliber vascular graft]". Kokyu To Junkan (in Japanese). 40 (5): 481–4. PMID 1589647.
  9. 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.
  10. 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.

Template:WH Template:WS