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How to Read Hep B Results Mnemonic

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Jaundice, or icterus, is a yellowish discoloration of tissue caused by the accumulation of bilirubin deposits. Bilirubin deposition most commonly occurs in the skin and the sclerae and becomes apparent when bilirubin levels reach > 2 mg/dL. Jaundice can exist divided into prehepatic, intrahepatic, and posthepatic etiologies. Prehepatic jaundice is caused by the accumulation of unconjugated bilirubin, which is due to either increased hemoglobin breakdown or dumb hepatic uptake. Intrahepatic jaundice may exist caused by intrahepatic cholestasis, dumb bilirubin conjugation, or impaired excretion of bilirubin by the liver. Posthepatic jaundice is caused by the accumulation of conjugated hyperbilirubinemia usually due to extrahepatic cholestasis from biliary obstruction. In jaundice that arises from cholestasis, patients may present with pruritus, nighttime urine, and pale stools. Diagnosis is based on laboratory studies (e.g., liver function tests) and, in most cases, a transabdominal right upper quadrant (RUQ) ultrasound. The handling of jaundice is determined by the underlying disease process and can frequently exist complemented with symptomatic treatment (e.chiliad., for pruritus) or ursodeoxycholic acrid.

Run into also "Neonatal jaundice."

  • Jaundice : y ellowish discoloration of the pare , sclerae, and mucous membranes due to the deposition of bilirubin
  • Cholestasis: dumb production, secretion, or outflow of bile
  • Hyperbilirubinemia : an increased serum concentration of bilirubin (Come across "Unconjugated hyperbilirubinemia" and "Conjugated hyperbilirubinemia" for details.)

Adult jaundice can be divided into prehepatic, intrahepatic, and posthepatic etiologies. See "Overview of mechanisms of neonatal jaundice" for etiologies of jaundice and kernicterus in neonates, e.grand., hemolytic illness of the newborn, congenital hypothyroidism, biliary atresia.

The near common causes of adult hyperbilirubinemia can be remembered with the mnemonic "HOT Liver": Hemolysis, Obstruction, Tumor, and Liver illness.

Prehepatic jaundice

Prehepatic jaundice is characterized by unconjugated hyperbilirubinemia most normally caused by increased hemoglobin breakdown .

Consider choledocholithiasis as an alternative explanation for jaundice in patients with chronic hemolysis, since they have a high incidence of pigmented gallstones (come across "Posthepatic jaundice"). [ane]

Intrahepatic jaundice

Intrahepatic jaundice can vary from unconjugated hyperbilirubinemia to conjugated hyperbilirubinemia to a combination based on the etiology. See also "Acute liver failure."

Causes of intrahepatic jaundice [1] [2]
Machinery Type of hyperbilirubinemia Conditions
Impaired bilirubin conjugation Unconjugated hyperbilirubinemia
  • Gilbert syndrome
  • Crigler-Najjar syndrome
Hepatocellular injury Mixed unconjugated and conjugated hyperbilirubinemia
  • Viral hepatitis : due east.g., hepatitis A–E, EBV, CMV, yellowish fever
  • Liver disease e.g., alcoholic hepatitis, nonalcoholic steatohepatitis, cirrhosis, congestive hepatopathy, Wilson disease, autoimmune hepatitis
  • Drug toxicity: e.g., acetaminophen, estrogens , macrolides , arsenic [4] [5]
Impaired hepatic excretion of bilirubin Conjugated hyperbilirubinemia
  • Dubin-Johnson syndrome
  • Rotor syndrome
Intrahepatic cholestasis
  • Intrahepatic biliary tract disorders: e.g., main biliary cholangitis , primary sclerosing cholangitis , vanishing bile duct syndrome, postoperative cholestasis
  • Infiltrative illness: e.grand., tuberculosis, sarcoidosis, amyloidosis, lymphoma
  • Progressive familial intrahepatic cholestasis
  • Intrahepatic cholestasis of pregnancy
  • Total parenteral nutrition
  • Nonhepatobiliary sepsis
  • Infectious diseases: due east.1000., malaria, icteric leptospirosis

Hepatitis and cirrhosis tin cause both conjugated and unconjugated hyperbilirubinemia.

Posthepatic jaundice

Posthepatic jaundice is characterized by conjugated hyperbilirubinemia caused by extrahepatic cholestasis from biliary obstruction .

  • Jaundice is due to an elevated level of serum bilirubin, which may exist caused by prehepatic, intrahepatic, or posthepatic defects .
  • Serum bilirubin concentration depends on the rate of formation and hepatobiliary elimination of bilirubin.
  • Any pathology that impairs the process could increase serum bilirubin level: See "Unconjugated hyperbilirubinemia" and "Conjugated hyperbilirubinemia" for details . [6]

Approach [1]

Depending on clinical suspicion, and in consultation with a specialist, boosted diagnostic procedures may be necessary, including:

  • Meet "Etiology" for a listing of underlying causes of adult jaundice .
  • Pseudojaundice [fourteen]
    • Carotenoderma
      • Deposition of carotene in the skin can also cause yellowish-orange discoloration of the peel .
      • Due to excessive consumption of multivitamin supplements or foods that are rich in beta carotene (e.chiliad., carrots, sweet potatoes, kale, oranges )
    • Addison disease: hyperpigmentation of the skin caused by increased melanin synthesis

In contrast to jaundice , pseudojaundice does not issue in scleral icterus.

The differential diagnoses listed here are not exhaustive.

Groundwork

  • Definition: elevated directly bilirubin (normal serum direct bilirubin: ≤ 0.3 mg/dL ) [20]
  • Pathogenesis : associated with intrahepatic and/or posthepatic conditions
    • ↓ Drainage of bilirubin via biliary tract
    • ↑ Reuptake of bilirubin

Diagnostics

Decide whether the liver chemistries suggest a hepatocellular or cholestatic etiology. Consult gastroenterology for further guidance if the cause is unclear.

Common laboratory findings for cholestasis: ↑ alkaline phosphatase (ALP), ↑ gamma-glutamyltransferase (GGT), and ↑ direct bilirubin

Hepatocellular injury

Provide supportive intendance and identify and treat the underlying condition in all patients . See also "Acute liver failure."

Elevated hepatocellular enzymes (e.k., AST, ALT) and varying degrees of jaundice are commonly seen in conditions that cause hyperbilirubinemia due to hepatocellular injury. Although elevations of both straight and indirect bilirubin are possible, a predominantly high direct bilirubin is most common, leading to mostly conjugated hyperbilirubinemia.

An AST:ALT ratio > 1.5:1 suggests alcoholic hepatitis .

Cholestasis

Definitions

  • Cholestasis: dumb production, secretion, or outflow of bile
  • Nonobstructive intrahepatic cholestasis: impaired bile formation or secretion
  • Obstructive intrahepatic cholestasis: biliary obstruction inside the liver
  • Obstructive extrahepatic or posthepatic cholestasis: obstruction of the biliary ducts between the liver and the duodenum

Management

Varying degrees of jaundice and elevations of cholestatic enzymes (including ALP, GGT, and straight bilirubin) are seen in conditions that cause conjugated hyperbilirubinemia due to cholestasis.

  1. Jameson JL, Fauci As, Kasper DL, Hauser SL, Longo DL, Loscalzo J. Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.one & Vol.2). McGraw-Hill Educational activity / Medical ; 2018
  2. Winger J, Michelfelder A. Diagnostic Approach to the Patient with Jaundice. Main Care: Clinics in Office Practice. 2011; 38 (3): p.469-482. doi: 10.1016/j.pop.2011.05.004 . | Open in Read by QxMD
  3. Maxwell MJ, Wilson JA. Complications of blood transfusion. Contin Educ Anaesth Crit Care Hurting. 2006; 6 (6): p.225-229. doi: ten.1093/bjaceaccp/mkl053 . | Open up in Read by QxMD
  4. Sundaram V, Björnsson ES. Drug-induced cholestasis. Hepatology Communications. 2017; 1 (8): p.726-735. doi: 10.1002/hep4.1088 . | Open in Read past QxMD
  5. Drug-Induced Cholestatic Liver Disease. In: Madame Curie Bioscience Database [Internet].
  6. Roche SP, Kobos R. Jaundice in the adult patient.. Am Fam Medico. 2004; 69 (two): p.299-304.
  7. Shroff H, Maddur H. Isolated Elevated Bilirubin. Clin. Liver Dis.. 2020; 15 (4): p.153-156. doi: x.1002/cld.944 . | Open up in Read past QxMD
  8. Phillips J, Henderson Air conditioning. Hemolytic Anemia: Evaluation and Differential Diagnosis. Am Fam Physician. 2018; 98 (6): p.354-361.
  9. George JN, Nester CM. Syndromes of Thrombotic Microangiopathy. North Engl J Med. 2014; 371 (7): p.654-666. doi: 10.1056/nejmra1312353 . | Open in Read by QxMD
  10. Goel R, Tobian AAR, Shaz BH. Noninfectious transfusion-associated adverse events and their mitigation strategies. Claret. 2019; 133 (17): p.1831-1839. doi: 10.1182/blood-2018-10-833988 . | Open in Read by QxMD
  11. Fretzayas A, Moustaki M, Liapi O, Karpathios T. Gilbert syndrome. Eur J Pediatr. 2011; 171 (1): p.11-15. doi: 10.1007/s00431-011-1641-0 . | Open in Read by QxMD
  12. Schiff ER, Bergasa NV. Advances in Hepatology: Electric current Developments in the Treatment of Hepatitis and Hepatobiliary Disease. Gastroenterol Hepatol. 2009; five (8): p.550–552.
  13. Bassari R, Koea JB. Jaundice associated pruritis: a review of pathophysiology and treatment. World J Gastroenterol. 2015; 21 (v): p.1404-1413. doi: 10.3748/wjg.v21.i5.1404 . | Open in Read by QxMD
  14. Feldman AG, Sokol RJ. Neonatal Cholestasis. NeoReviews. 2013; 14 (2): p.e63-e73. doi: 10.1542/neo.14-ii-e63 . | Open in Read past QxMD
  15. American Higher of Radiology ACR Appropriateness Criteria® Jaundice. https://acsearch.acr.org/docs/69497/Narrative/. Updated: January 1, 2018. Accessed: May 26, 2020.
  16. Walls R, Hockberger R, Gausche-Hill One thousand. Rosen's Emergency Medicine. Elsevier Health Sciences ; 2018
  17. Singal AK, Bataller R, Ahn J, Kamath PS, Shah VH. ACG Clinical Guideline: Alcoholic Liver Disease. Am J Gastroenterol. 2018; 113 (ii): p.175-194. doi: 10.1038/ajg.2017.469 . | Open in Read past QxMD
  18. Crabb DW, Im GY, Szabo Thou, Mellinger JL, Lucey MR. Diagnosis and Treatment of Booze‐Associated Liver Diseases: 2019 Practice Guidance From the American Association for the Study of Liver Diseases. Hepatology. 2020; 71 (ane): p.306-333. doi: 10.1002/hep.30866 . | Open up in Read by QxMD
  19. Crabb DW, Bataller R, Chalasani NP, et al. Standard Definitions and Common Data Elements for Clinical Trials in Patients With Alcoholic Hepatitis: Recommendation From the NIAAA Alcoholic Hepatitis Consortia. Gastroenterology. 2016; 150 (4): p.785-790. doi: x.1053/j.gastro.2016.02.042 . | Open in Read by QxMD
  20. Yoon E, Babar A, Choudhary M, Kutner M, Pyrsopoulos N. Acetaminophen-Induced Hepatotoxicity: a Comprehensive Update.. Journal of clinical and translational hepatology. 2016; 4 (2): p.131-42. doi: 10.14218/JCTH.2015.00052 . | Open in Read by QxMD
  21. Korman JD, Volenberg I, Balko J, et al. Screening for Wilson illness in acute liver failure: a comparison of currently bachelor diagnostic tests.. Hepatology. 2008; 48 (4): p.1167-74. doi: ten.1002/hep.22446 . | Open up in Read past QxMD
  22. Younossi ZM, Bernstein D, Shiffman ML, et al. Diagnosis and Management of Primary Biliary Cholangitis. Am J Gastroenterol. 2019; 114 (ane): p.48-63. doi: 10.1038/s41395-018-0390-three . | Open in Read by QxMD
  23. Lahmann Be, Adrales G, Schwartz RW. Choledocholithiasis—principles of diagnosis and direction. Current Surgery. 2004; 61 (3): p.290-293. doi: 10.1016/j.cursur.2003.07.014 . | Open in Read by QxMD
  24. Mosler P. Diagnosis and Management of Acute Cholangitis. Curr Gastroenterol Rep. 2011; 13 (two): p.166-172. doi: ten.1007/s11894-010-0171-7 . | Open in Read by QxMD
  25. Khandelwal C, Anand U, Kumar B, Priyadarshi RN. Diagnosis and Management of Choledochal Cysts. Indian J Surg. 2011; 74 (1): p.29-34. doi: ten.1007/s12262-011-0388-1 . | Open in Read by QxMD
  26. Simerville et al.. Urinalysis: A Comprehensive Review. American Family unit Physician. undefined; 71 (6).
  27. American College of Radiology ACR Appropriateness Criteria® Right Upper Quadrant Hurting. https://acsearch.acr.org/docs/69474/Narrative/. Updated: January 1, 2018. Accessed: August 28, 2019.
  28. Allan PLP, Baxter GM, Weston MJ. Clinical Ultrasound. Elsevier Health Sciences ; 2011
  29. Webb WR, Brant Nosotros, Major NM. Fundamentals of Body CT. Saunders ; 2014
  30. Fletcher LL, Thomas DJ. The claiming of diagnosing the cause of jaundice.. Nurse Pract. 1999; 24 (ten): p.98-102.

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