Jaundice

Revision as of 12:07, 14 March 2011 by Rossdonaldson1 (talk | contribs)

Background

  1. One end product of heme metabolism; remainder from myoglobin
  2. All bilirubin products in the body are initially UNconjugated
  3. Transported from albumin into liver cells; combined with glucuronic acid into conjugated bilirubin
  4. Excreted into the biliary tract in conjugated form

Workup

  1. Icon
  2. CBC
  3. Chem 7
  4. LFTs
  5. Lipase
  6. UA
  7. Coags
  8. ?Ammonia
  9. ?US vs. CT
  10. ?Retic count
  11. ?Haptoglobin/LDH
  12. ?Tylenol/ASA/Utox/ETOH

Diagnosis

Masqueraders:

  1. Carotenemia
  2. Quinacrine ingestion
  3. Dinitrophenol, teryl (explosive chemicals)

NB: Only bilirubin stains the sclera

DDX

  1. Indirect >> direct (Hematologic) [near nl AST/ALT/Alk P/PT/PTT]
    1. Hemolytic
      1. G6PD
      2. Drug related
      3. Autoimmune
    2. Hematoma resorption
    3. Infective erythropoiesis
    4. Gilbert's
  2. Direct >> indirect
    1. Increased Alk P (Obstructive) [nl to mild inc AST/ALT]
    2. Choledocholithiasis
    3. Cholecystitis
    4. Cholangitis (Ascending)
    5. AIDS cholangiopathy
    6. Stricture
    7. Neoplasm
      1. Panc head
      2. Gallbladder
      3. Primary liver
      4. Metastatic
    8. Obstructing AAA
  3. Nl Alk P (Hepatocellular/cholestatic) [greatly elevated AST/ALT]
    1. Viral hepatitis
    2. Fulminant hepatic failure
    3. ETOH hepatitis
    4. Ischemia
    5. Toxins
      1. isoniazide
      2. phenytoin
      3. acetaminophen
      4. ritonavir
      5. halothane
      6. sulronamide
    6. Autoimmune hepatitis
      1. 1 biliary cirhosis
    7. HELLP syndrome
    8. Congestive
      1. CHF
      2. Sepsis

Pregnancy Related

  1. HELP
  2. Acute fatty liver
  3. Hyperemesis gravidarum
  4. Cholestasis of pregnancy

Transplant Related

  1. Transplant regection
  2. Graft-vs-host

Peds Related

  1. Inborn error of metabolism
  2. Physiologic neonatal

Additional DDX

  1. Reye's syndrome
  2. TPN
  3. Heatstroke
  4. Budd-Chiari (with acute ascites)
  5. Wilson's
  6. Sarcoidosis
  7. Amyloidosis

Disposition

NEW ONSET JAUNDICE ADMIT CRITERIA

  1. Transaminase >1000IU/L
  2. Tbil >10mg/dL
  3. Evidence coagulopathy

See Also

Peds: Neonatal Jaundice

GI: Viral Hepatis

Source

3/14/06 DONALDSON (adapted from Rosen), H-N

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