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 BilirubinUnconjugated 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 (hemolyticdisordersandineffectiveerythropoiesis)orfromimpairedhepaticuptake/conjugation of bilirubin (drug effect or genetic disorders).Table 43-1 Causes of Isolated HyperbilirubinemiaI. Indirect hyperbilirubinemia ...
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Chapter 043. Jaundice (Part 3) Chapter 043. Jaundice (Part 3) Evaluation of the patient with jaundice. MRCP, magnetic resonancecholangiopancreatography; ALT, alanine aminotransferase; AST, aspartateaminotransferase; SMA, smooth-muscle antibody; AMA, antimitochondrialantibody; LKM, liver-kidney microsomal antibody; SPEP, serum proteinelectrophoresis; CMV, cytomegalovirus; EBV, Epstein-Barr virus. Isolated Elevation of Serum Bilirubin Unconjugated Hyperbilirubinemia The differential diagnosis of an isolated unconjugated hyperbilirubinemia islimited (Table 43-1). The critical determination is whether the patient is sufferingfrom a hemolytic process resulting in an overproduction of bilirubin (hemolyticdisorders and ineffective erythropoiesis) or from impaired hepaticuptake/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 hemolysisB. Ineffective erythropoiesis 1. Cobalamin, folate, thalassemia, and severe iron deficiencies C. Drugs 1. Rifampicin, probenecid, ribavirin D. Inheritedconditions 1. Crigler- Najjar types I and II 2. Gilberts syndromeII. Direct hyperbilirubinemia A. Inherited conditions 1. Dubin-Johnsonsyndrome 2. Rotorssyndrome