Jaundice differential diagnosis: Difference between revisions

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Revision as of 16:57, 19 December 2017

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mehrian Jafarizade, M.D [2]

Overview

Jaundice is yellowish discoloration of the skin, conjunctiva, and mucous membranes caused by hyperbilirubinemia. Usually, the concentration of bilirubin in the blood must exceed 2–3 mg/dL for the coloration to be easily visible. This page contains different causes of jaundice.

Differential diagnosis of jaundice

The differential diagnosis for jaundice, click here.

The differential diagnosis for jaundice and RUQ pain, click here.

The differential diagnosis for jaundice and pruritis, click here.

The differential diagnosis for jaundice and fever, click here.

The differential diagnosis for jaundice, fever, and RUQ pain, click here.

The differential diagnosis for jaundice, pruritis and RUQ pain, click here.

Differential diagnosis of jaundice are: ^[1]^[2]^[3]^[4]

Classification of jaundice based on etiology		Disease	History and clinical manifestations				Diagnosis
			History and clinical manifestations				Lab Findings						Other blood tests	Other diagnostic
			Family history	Fever	RUQ Pain	Pruritis	AST	ALT	ALK	BLR Indirect	BLR Direct	Viral serology	Other blood tests	Other diagnostic
Jaundice	Hepatocellular Jaundice	Liver infiltration: Hemochromatosis, amyloidosis	+	-	-/+	-	↑	↑	↑/N	↑/N	N	-	Ferritin ↑ in hemochromatosis	Liver biopsy
		Wilson's disease	+	-	-/+	-	↑	↑	N	↑/N	N	-	Serum cerulloplasmin ↑	Liver biopsy
		Viral hepatitis	-	-/+	-	-	↑	↑	N	↑/N	N	+	Specific viral antibody for each type	-
		Alcoholic hepatitis	-	-/+	-/+	-	↑↑	↑	N	↑/N	N	-	-	-
		Drug induced hepatitis	-	-/+	-	-	↑	↑	N	↑/N	N	-	-	-
		Autoimmune hepatitis	-/+	-	-	-/+	↑	↑	N	↑/N	N	-	Anti-LKM antibody	Liver biopsy
		Cirrhosis	-/+	-/+	-/+	-	↑	↑	↑/N	↑/N	↑/N	-/+	Low platate	Small liver on ultrasond
		Nonalcoholic steatohepatitis	-/+	-	-	-	↑	↑	N	↑/N	N	-	High lipids	liver biopsy
		Ischemic hepatopathy	-/+	-	-/+	-	↑	↑	N	↑/N	N	-	Cardiovascular risk factors	Clinical setting
	Cholestatic Jaundice	Common bile duct stone	-/+	-	+	+	N	N	↑	N	↑	-	Dilated ducts on sono	CT/ERCP
		Hepatitis A cholestatic type	-	-/+	+	+	N	N	↑	N	↑	+	HAV- AB	Abdominal ultrasound
		EBV / CMV hepatitis	-	-/+	+	+	N	N	↑	N	↑	+	Positive serology	-
		Primary biliary cirrhosis	-/+	-	-/+	+	N/↑	N/↑	↑	N	↑	-	AMA positive	Liver biopsy
		Primary sclerosing cholangitis	-/+	-	-/+	+	N/↑	N/↑	↑	N	↑	-	Pos. autoantibodies	Beading on MRCP, Liver biopsy
		Sickle cell disease	+	-	-	+/-	N/↑	N/↑	↑	N	↑	-	Genetic testing
		Pancreatic carcinoma	+	-	-/+	-/+	N/↑	N/↑	↑	N	↑	-	-	CT scan for diagnosis
		AIDS cholangiopathy	-	-	-/+	-/+	N/↑	N/↑	↑	N	↑	-	Pos. HIV	Sono or ERCP for diagnosis
		Parasites induces cholestasis	-	-	-/+	-/+	N/↑	N/↑	↑	N	↑	-	Ab or parasite serology	Sono or ERCP for diagnosis
		Intrahepatic cholestasis of pregnancy	-/+	-	-/+	+	↑	↑	↑	N	↑	-	Low PLT, Neg viral serology	Diagnosed clinically
	Isolated Jaundice	Crigler-Najjar type 2	+	-	-	-	N	N	N	↑	↑	-	Genetic testing
		Gilbert	+	-	-	-	N	N	N	↑	↑	-	Genetic testing
		Rotor syndrome	+	-	-	-	N	N	N	N	↑	-	Genetic testing	Liver biopsy
		Dubin-Johnson syndrome	+	-	-	-	N	N	N	N	↑	-	Genetic testing	Liver biopsy
		Hereditory spherocytosis	+	-	-/+	-	N	N	N	↑	N	-	Genetic testing	Osmotic fragility
		G6PD deficiency	+	-	-	-	N	N	N	↑	N	-	Genetic testing
		Thalassemia	+	-	-	-	N	N	N	↑	N	-	Genetic testing
		Paroxismal nocturnal hemoglobinoria	-	-	-	-	N	N	N	↑	N	-	Flocytometery
		Immune hemolysis	-	-/+	-	-	N	N	N	↑	N	-	Autoantibodies
		Hematoma	-	-/+	-	-	N	N	N	↑	N	-	Anemia	Truma or surgery in history

References

↑ Fargo MV, Grogan SP, Saguil A (2017). "Evaluation of Jaundice in Adults". Am Fam Physician. 95 (3): 164–168. PMID 28145671.
↑ Leevy CB, Koneru B, Klein KM (1997). "Recurrent familial prolonged intrahepatic cholestasis of pregnancy associated with chronic liver disease". Gastroenterology. 113 (3): 966–72. PMID 9287990.
↑ Hov JR, Boberg KM, Karlsen TH (2008). "Autoantibodies in primary sclerosing cholangitis". World J. Gastroenterol. 14 (24): 3781–91. PMC 2721433. PMID 18609700.
↑ Bond LR, Hatty SR, Horn ME, Dick M, Meire HB, Bellingham AJ (1987). "Gall stones in sickle cell disease in the United Kingdom". Br Med J (Clin Res Ed). 295 (6592): 234–6. PMC 1247079. PMID 3115390.

[pmid28145671-1] Fargo MV, Grogan SP, Saguil A (2017). "Evaluation of Jaundice in Adults". Am Fam Physician. 95 (3): 164–168. PMID 28145671.

[pmid9287990-2] Leevy CB, Koneru B, Klein KM (1997). "Recurrent familial prolonged intrahepatic cholestasis of pregnancy associated with chronic liver disease". Gastroenterology. 113 (3): 966–72. PMID 9287990.

[pmid18609700-3] Hov JR, Boberg KM, Karlsen TH (2008). "Autoantibodies in primary sclerosing cholangitis". World J. Gastroenterol. 14 (24): 3781–91. PMC 2721433. PMID 18609700.

[pmid3115390-4] Bond LR, Hatty SR, Horn ME, Dick M, Meire HB, Bellingham AJ (1987). "Gall stones in sickle cell disease in the United Kingdom". Br Med J (Clin Res Ed). 295 (6592): 234–6. PMC 1247079. PMID 3115390.

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@@ Line 47: / Line 47: @@
 ! colspan="1" rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |Viral serology
 |-
-! rowspan="26" align="center" style="background:#4479BA; color: #FFFFFF;" |Jaundice
+! rowspan="30" align="center" style="background:#4479BA; color: #FFFFFF;" |Jaundice
-! colspan="1" rowspan="7" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Hepatocellular Jaundice
+! colspan="1" rowspan="9" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Hepatocellular Jaundice
-| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Hemochromatosis
+| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Liver infiltration: Hemochromatosis, amyloidosis
 | style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
 | style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
@@ Line 60: / Line 60: @@
 | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N
 | style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Ferritin ↑
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Ferritin ↑ in hemochromatosis
 | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Liver biopsy
 |-
@@ Line 147: / Line 147: @@
 | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Small liver on ultrasond
 |-
-! rowspan="8" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Cholestatic Jaundice
+!Nonalcoholic steatohepatitis
+!-/+
+!-
+!-
+!-
+|↑
+|↑
+|N
+|↑/N
+|N
+| -
+!High lipids
+!liver biopsy
+|-
+!Ischemic hepatopathy
+!-/+
+!-
+!-/+
+!-
+|↑
+|↑
+|N
+|↑/N
+|N
+| -
+!Cardiovascular risk factors
+!Clinical setting
+|-
+! rowspan="10" style="padding: 5px 5px; background: #DCDCDC;" align="center" | Cholestatic Jaundice
 | colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Common bile duct stone
 | style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
@@ Line 236: / Line 264: @@
 | style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
 | style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
-| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
+| style="padding: 5px 5px; background: #F5F5F5;" align="center" | -/+
 | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N/↑
 | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N/↑
@@ Line 245: / Line 273: @@
 | style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
 | style="padding: 5px 5px; background: #F5F5F5;" align="center" |CT scan for diagnosis
+|-
+! AIDS cholangiopathy
+!-
+!-
+!-/+
+!-/+
+|N/↑
+|N/↑
+|↑
+|N
+|↑
+| -
+!Pos. HIV
+!Sono or ERCP for diagnosis
+|-
+!Parasites induces cholestasis
+!-
+!-
+!-/+
+!-/+
+|N/↑
+|N/↑
+|↑
+|N
+|↑
+| -
+!Ab or parasite serology
+!Sono or ERCP for diagnosis
 |-
 | colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |Intrahepatic cholestasis of pregnancy

Jaundice differential diagnosis: Difference between revisions

Revision as of 16:57, 19 December 2017

Overview

Differential diagnosis of jaundice

References

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