Approach to hyperbilirubinemia in adults HY
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Approach to hyperbilirubinemia in adults
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Approach to hyperbilirubinemia in adults HY
- 1. Approach to hyperbilirubinemia in adults Hyperbilirubinemia Possible causes • Overproduction (hemolysis) • Reduced uptake (drugs, portosystemic shunt) • Conjugation defect (Gilbert syndrome) Evaluate liver enzyme pattern Normal AST, ALT, ALP • Dubin-Johnson syndrome • Rotor syndrome Predominantly elevated AST & ALT • Viral hepatitis • Autoimmune hepatitis • Toxin/drug-related hepatitis • Hemochromatosis • Ischemic hepatitis • Alcoholic hepatitis Predominantly elevated ALP • Cholestasis of pregnancy • Malignancy (pancreas, ampullary) • Cholangiocarcinoma • Primary biliary cholangitis • Primary sclerosing cholangitis • Choledocholithiasis • Abdominal imaging (US/CT) • Antimitochondrial antibody Mainly unconjugated Mainly conjugated