Jaundice: Difference between revisions
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==Background== | ==Background== | ||
*Bilirubin is end product of heme metabolism | |||
**All bilirubin products in the body are initially unconjugated | |||
**Transported from albumin into hepatocytes; combine with glucuronic acid into conj bili | |||
***Excreted into biliary tract in conjugated form | |||
*Only conjugated bilirubin is water-soluble (present in urine) | |||
*Types: | |||
**Prehepatic (overproduction) | |||
***Hemolysis | |||
***Primarily unconj bili | |||
**Hepatic (inadequate processing) | |||
***Viral, alcohol, toxin | |||
***Primarily unconj bili | |||
**Posthepatic (underexcretion) | |||
***Pancreatic tumor, choledocholithiasis | |||
==Workup== | ==Workup== | ||
# | #Urine pregnancy | ||
#CBC | #CBC | ||
# | #Chemistry | ||
#LFTs | #LFTs | ||
#Lipase | #Lipase | ||
| Line 92: | Line 102: | ||
==Disposition== | ==Disposition== | ||
New Onset Jaundice Admission Criteria | |||
#Transaminase >1000IU/L | #Transaminase >1000IU/L | ||
#Tbil >10mg/dL | #Tbil >10mg/dL | ||
| Line 98: | Line 108: | ||
==See Also== | ==See Also== | ||
*[[Neonatal Jaundice]] | |||
*[[Hepatitis]] | |||
==Source == | ==Source == | ||
Revision as of 05:32, 1 August 2011
Background
- Bilirubin is end product of heme metabolism
- All bilirubin products in the body are initially unconjugated
- Transported from albumin into hepatocytes; combine with glucuronic acid into conj bili
- Excreted into biliary tract in conjugated form
- Only conjugated bilirubin is water-soluble (present in urine)
- Types:
- Prehepatic (overproduction)
- Hemolysis
- Primarily unconj bili
- Hepatic (inadequate processing)
- Viral, alcohol, toxin
- Primarily unconj bili
- Posthepatic (underexcretion)
- Pancreatic tumor, choledocholithiasis
- Prehepatic (overproduction)
Workup
- Urine pregnancy
- CBC
- Chemistry
- LFTs
- Lipase
- UA
- Coags
- ?Ammonia
- ?US vs. CT
- ?Retic count
- ?Haptoglobin/LDH
- ?Tylenol/ASA/Utox/ETOH
Diagnosis
Masqueraders:
- Carotenemia
- Quinacrine ingestion
- Dinitrophenol, teryl (explosive chemicals)
NB: Only bilirubin stains the sclera
DDX
- Indirect >> direct (Hematologic) [near nl AST/ALT/Alk P/PT/PTT]
- Hemolytic
- G6PD
- Drug related
- Autoimmune
- Hematoma resorption
- Infective erythropoiesis
- Gilbert's
- Hemolytic
- Direct >> indirect
- Increased Alk P (Obstructive) [nl to mild inc AST/ALT]
- Choledocholithiasis
- Cholecystitis
- Cholangitis (Ascending)
- AIDS cholangiopathy
- Stricture
- Neoplasm
- Panc head
- Gallbladder
- Primary liver
- Metastatic
- Obstructing AAA
- Nl Alk P (Hepatocellular/cholestatic) [greatly elevated AST/ALT]
- Viral hepatitis
- Fulminant hepatic failure
- ETOH hepatitis
- Ischemia
- Toxins
- isoniazide
- phenytoin
- acetaminophen
- ritonavir
- halothane
- sulronamide
- Autoimmune hepatitis
- 1 biliary cirhosis
- HELLP syndrome
- Congestive
- CHF
- Sepsis
Pregnancy Related
- HELP
- Acute fatty liver
- Hyperemesis gravidarum
- Cholestasis of pregnancy
Transplant Related
- Transplant regection
- Graft-vs-host
Peds Related
- Inborn error of metabolism
- Physiologic neonatal
Additional DDX
- Reye's syndrome
- TPN
- Heatstroke
- Budd-Chiari (with acute ascites)
- Wilson's
- Sarcoidosis
- Amyloidosis
Disposition
New Onset Jaundice Admission Criteria
- Transaminase >1000IU/L
- Tbil >10mg/dL
- Evidence coagulopathy
See Also
Source
3/14/06 DONALDSON (adapted from Rosen), H-N