Jaundice Differential Diagnosis*
Measure bilirubin
† Indirect bilirubin
† Direct bilirubin
Unconjucated B.
Impaired hepatic intake, hemolysis or defective conjucation
ー
CBC
Retic T
Retic t
+ ALT, AST
Hemolysis
RBCs are being destroyed →
excess bilirubin
Non-Hemolytic
There is an error in bilirubin conjucation
Hepatocellular
Injury
Hepatocytes are being destroyed and releasing ALT/AST
Next Steps
Blood film
Next Steps
Family Hx
ALT > AST
AST:ALT > 2
Viral serology
LFTs
Genetic studies
Next Steps
Viral serology
Possible diagnoses
Alcoholic Liver D.
ANA & ASMA
Hepatocellular ca
Possible diagnoses
G6PD
Possible diagnoses
Gilbert S.
AMA
Early Viral Hepatitis
Transferrins
Sickle Cell A.
AIHA
Crigler-Najjar S.
a1 antitrypsin
Neonatal Jaundice
МАНА
Possible diagnoses
Late Viral Hepatitis
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Acute Hepatic Injury
Toxins and Drugs
Conjucated B.
Hepatocellular injury, cholestasis or impaired excretion
LFT
rALP, GGT
Cholestasis
Bilirubin is being excreted in bile but is being trapped and is causing damage
Next Steps
Bile duct U/S
MRCP / ERCP
Possible diagnoses
Choledochlithiasis
Primary Sclerosing C.
Obstructing Tumors
Any liver disease
Pregnancy
Designed by Khudhur M.
khudhur_moh
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me@khudhur.com
Normal
+ Excretion / Reuptake
of Bilirubin
Bilirubin is getting conjucated but trapped
Next Steps
Genetic studies
Histological studies
Family Hx
Possible diagnoses
Dubin-Johnson S.
Rotor S.

Jaundice: differential diagnosis