Chapter 043. Jaundice (Part 3) ppt

Jaundice Part 3 Evaluation of the patient with jaundice.. MRCP, magnetic resonance cholangiopancreatography; ALT, alanine aminotransferase; AST, aspartate aminotransferase; SMA, smooth

Chapter 043 Jaundice

(Part 3)

Evaluation of the patient with jaundice MRCP, magnetic resonance

cholangiopancreatography; ALT, alanine aminotransferase; AST, aspartate aminotransferase; SMA, smooth-muscle antibody; AMA, antimitochondrial antibody; LKM, liver-kidney microsomal antibody; SPEP, serum protein electrophoresis; CMV, cytomegalovirus; EBV, Epstein-Barr virus

Isolated Elevation of Serum Bilirubin

Unconjugated Hyperbilirubinemia

The differential diagnosis of an isolated unconjugated hyperbilirubinemia is limited (Table 43-1) The critical determination is whether the patient is suffering from a hemolytic process resulting in an overproduction of bilirubin (hemolytic

disorders and ineffective erythropoiesis) or from impaired hepatic

uptake/conjugation of bilirubin (drug effect or genetic disorders)

Table 43-1 Causes of Isolated Hyperbilirubinemia

I Indirect hyperbilirubinemia

A Hemolytic disorders

1 Inherited

a Spherocytosis, elliptocytosis

Glucose-6-phosphate dehydrogenase and pyruvate kinase deficiencies

b

Sickle cell anemia

2 Acquired

a Microangiopathic hemolytic anemias

b Paroxysmal nocturnal hemoglobinuria

c

Spur cell anemia

d

Immune hemolysis

B Ineffective erythropoiesis

1 Cobalamin, folate, thalassemia, and severe iron deficiencies

C Drugs

1 Rifampicin, probenecid, ribavirin

D Inherited conditions

1 Crigler-Najjar types I and II

2 Gilbert's syndrome

II Direct hyperbilirubinemia

A Inherited conditions

1

Dubin-Johnson syndrome

2 Rotor's syndrome