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{{Jaundice}}
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==Overview==
==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 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 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).


==Laboratory Findings==
* Laboratory findings consistent with the diagnosis of jaundice include:
** 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.<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>
* Hyperbilirubinemia can be further categorized as conjugated or unconjugated:
* Hyperbilirubinemia can be further categorized as conjugated or unconjugated:
** Conjugated hyperbilirubinemia:
** [[Conjugated bilirubin|Conjugated]] hyperbilirubinemia:
***  Serum conjugated bilirubin concentration >0.4 mg/dL (6.8 micromol/L).
*** 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).<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>
*** Direct bilirubin >1 mg/dL (17 micromol/L) if the total bilirubin is <5 mg/dL (85 micromol/L).
** Unconjugated hyperbilirubinemia:
*** More than 20 percent of the total bilirubin if the total bilirubin is >5 mg/dL (85 micromol/L).
***  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).<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>
** [[Unconjugated bilirubin|Unconjugated]] hyperbilirubinemia:
**  
*** Conjugated bilirubin is <1 mg/dL (17 micromol/L) if the total bilirubin is <5 mg/dL.
* [[Aspartate transaminase]](AST) (or) SGOT
*** Less than 20 percent of the total bilirubin if the total bilirubin is >5 mg/dL (85 micromol/L).
* [[Alanine transaminase]](ALT) (or) SGPT
 
* [[Albumin]]
=== Liver function tests ===
* [[Alkaline phosphatase]]
* '''[[Alkaline phosphatase]]:'''
* [[HIV]] serologies
** 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>
* [[Hepatitis]] serologies
*** [[Gallstones]] causing bile duct obstruction
* [[Antinuclear antibody]] (ANA)
*** [[Pancreatic cancer|Pancreatic cance]]<nowiki/>r
* [[Antimitochondrial antibodies]]
*** [[Pregnancy]]
* [[Haptoglobin]]
*** Drugs
* [[Reticulocyte count]]
*** Rarely [[primary biliary cirrhosis]]
* [[Leukocytosis]]
* '''[[Transaminase|Liver transaminases]]'''
* [[Lactic dehydrogenase]] (LDH)
** 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: ===


Inalcoholic hepatitis the aspartate aminotransferase:alanine aminotransferase ratio is > 2 (AST:ALT)
==== 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}}
{{WH}}
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Latest revision as of 22:27, 29 July 2020

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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.[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.

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