Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mehrian Jafarizade, M.D [2]
Differential diagnosis of jaundice
Abbreviations:
RUQ= Right upper quadrant of the abdomen, LFT= Liver function test, SIRS= Systemic inflammatory response syndrome, ERCP= Endoscopic retrograde cholangiopancreatography, N= Normal, AMA= Anti mitochondrial antibodies, LDH= Lactate dehydrogenase, GI= Gastrointestinal, CT= Computed tomography
| Classification of jaundice based on etiology
|
Disease
|
History and clinical manifestations
|
Diagnosis
|
| Lab Findings
|
Other blood tests
|
Other diagnostic
|
| Family history
|
Fever
|
RUQ Pain
|
Pruritis
|
AST
|
ALT
|
ALK
|
BLR Indirect
|
BLR Direct
|
Viral serology
|
| Jaundice
|
Hepatocellular Jaundice
|
Hemochromatosis
|
+
|
-
|
-/+
|
-
|
↑
|
↑
|
↑/N
|
↑/N
|
N
|
-
|
Ferritin ↑
|
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
|
| 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
|
↑
|
-
|
Beading on MRCP
|
Liver biopsy
|
| Pancreatic carcinoma
|
+
|
-
|
-/+
|
-
|
N/↑
|
N/↑
|
↑
|
N
|
↑
|
-
|
Mass on ultrasond
|
CT scan for diagnosis
|
| 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
|
| Sickle cell disease
|
+
|
-
|
-
|
-
|
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
|
|
The differential diagnosis for jaundice and pruritis are:
| Disease
|
History and clinical manifestations
|
Diagnosis
|
| Lab Findings
|
Other blood tests
|
Other diagnostic
|
| AST
|
ALT
|
ALK
|
BLR Indirect
|
BLR Direct
|
Viral serology
|
| Type of jaundice
|
Pruritis
|
Family history
|
| Common bile duct stone
|
Cholestatic Jaundice
|
+
|
-/+
|
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
|
PCR or ELISA
|
| Primary biliary cirrhosis
|
+
|
-/+
|
N/↑
|
N/↑
|
↑
|
N
|
↑
|
-
|
AMA positive
|
Liver biopsy
|
| Primary sclerosing cholangitis
|
+
|
-/+
|
N/↑
|
N/↑
|
↑
|
N
|
↑
|
-
|
Beading on MRCP
|
Liver biopsy
|
| Autoimmune hepatitis
|
Hepatocellular Jaundice
|
-/+
|
-/+
|
↑
|
↑
|
N
|
↑/N
|
N
|
-
|
Anti-LKM antibody
|
Liver biopsy
|
|
The differential diagnosis for jaundice and pruritis and RUQ pain are:
| Disease
|
History and clinical manifestations
|
Diagnosis
|
| Lab Findings
|
Other blood tests
|
Other diagnostic
|
| AST
|
ALT
|
ALK
|
BLR Indirect
|
BLR Direct
|
Viral serology
|
| Type of jaundice
|
Pruritis
|
RUQ pain
|
Fever
|
Family history
|
| Common bile duct stone
|
Cholestatic Jaundice
|
+
|
+
|
-
|
-/+
|
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
|
PCR or ELISA
|
| Primary biliary cirrhosis
|
+
|
-/+
|
-
|
-/+
|
N/↑
|
N/↑
|
↑
|
N
|
↑
|
-
|
AMA positive
|
Liver biopsy
|
| Primary sclerosing cholangitis
|
+
|
-/+
|
-
|
-/+
|
N/↑
|
N/↑
|
↑
|
N
|
↑
|
-
|
Beading on MRCP
|
Liver biopsy
|
|
The differential diagnosis for jaundice and pruritis and RUQ pain are:
| Classification of jaundice based on etiology
|
Disease
|
History and clinical manifestations
|
Diagnosis
|
| Lab Findings
|
Other blood tests
|
Other diagnostic
|
| Family history
|
Fever
|
RUQ Pain
|
Pruritis
|
AST
|
ALT
|
ALK
|
BLR Indirect
|
BLR Direct
|
Viral serology
|
| Jaundice
|
Cholestatic Jaundice
|
Common bile duct stone
|
-/+
|
-
|
+
|
+
|
N
|
N
|
↑
|
N
|
↑
|
-
|
Dilated ducts on ultrasond
|
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
|
↑
|
-
|
Beading on MRCP
|
Liver biopsy
|
|