Jaundice laboratory findings: Difference between revisions
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*** ALT is raised more than AST in acute hepatitis and in extrahepatic obstruction. | *** ALT is raised more than AST in acute hepatitis and in extrahepatic obstruction. | ||
** [[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> | ** [[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 MCV with raised GGT | *** A raised MCV with raised GGT suggests alcohol abuse and, if accompanied by raised ALT, suggests liver cell damage. | ||
*** Very high GGT levels (x 10 normal) | *** Very high GGT levels (x 10 normal) suggests Biliary obstruction and hepatic malignancies. | ||
*** Raised GGT with raised alkaline phosphatase (over x 3 normal) suggests [[cholestasis]]. | *** Raised GGT with raised alkaline phosphatase (over x 3 normal) suggests [[cholestasis]]. | ||
* Hepatitis serology: | * Hepatitis serology: | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Laboratory Findings
- Laboratory findings consistent with the diagnosis of jaundice include:[1]
- 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.
- 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), or 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, or less than 20 percent of the total bilirubin if the total bilirubin is >5 mg/dL (85 micromol/L).
- Conjugated hyperbilirubinemia:
- FBC detect haemolysis.
- ESR may be rise in PBC.
- Lactate dehydrogenase elevated in haemolysis.
- LFTs:
- Alkaline phosphatase: The most common diseases associated with elevated alkaline phosphatase include:[2]
- Gallstones causing bile duct obstruction
- Pancreatic cancer
- Pregnancy
- Drugs
- More rarely, PBC
- Serum transaminases are usually very high in viral hepatitis.
- Aspartate aminotransferase (AST) is raised more than alanine aminotransferase (ALT) in cirrhosis, intrahepatic neoplasia, haemolytic jaundice and alcoholic hepatitis.
- ALT is raised more than AST in acute hepatitis and in extrahepatic obstruction.
- Gamma-glutamyltransferase (GGT):[3][4]
- A raised MCV with raised GGT suggests alcohol abuse and, if accompanied by raised ALT, suggests liver cell damage.
- Very high GGT levels (x 10 normal) suggests Biliary obstruction and hepatic malignancies.
- Raised GGT with raised alkaline phosphatase (over x 3 normal) suggests cholestasis.
- Alkaline phosphatase: The most common diseases associated with elevated alkaline phosphatase include:[2]
- Hepatitis serology:
- screen for viral hepatitis.[5]
- Serum antinuclear antibodies (ANAs), anti-smooth muscle antibody (ASMA):
- the hallmark of PBC is antimitochondrial antibodies (90-95% of patients with PBC are positive)
- ANA is positive in 20-50% of patients with PBC.
- Serum immunoglobulins and serum electrophoresis :
- IgG is raised in acute hepatitis
- IgM is raised in autoimmune disease, PBC or chronic infection.
- Alpha-1-antitrypsin levels:
- deficiency causes cirrhosis
References
- ↑ Walker HK, Hall WD, Hurst JW, Stillman AE. PMID 21250253. Missing or empty
|title=(help) - ↑ 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.
- ↑ 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.
- ↑ Goldberg DM (1980). "Structural, functional, and clinical aspects of gamma-glutamyltransferase". CRC Crit Rev Clin Lab Sci. 12 (1): 1–58. PMID 6104563.
- ↑ Fields, Bernard (2007). Fields virology. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN 0781760607.