Liver Function Tests:- Part 3 – Differential Diagnosis of Jaundice
Differential diagnosis of jaundice
Sample for liver function test
- The serum of the patient is needed.
- Don’t expose the sample to light.
- The liver function tests can differentiate various types of jaundice due to liver diseases.
Differential diagnosis of jaundice and LFT findings:
Disease | Urine | Stool | Serum Bilirubin | Serum cholesterol | |
Tests | Bilirubin | Urobilinogen | Bilirubin Urobilinogen | Direct Indirect | Cholesterol |
Viral Hepatitis | Inc | N or Inc | Dec Dec | Inc Inc | N or dec |
Hepatitis due to drugs | Inc | N or Inc | Dec Dec | Inc Inc | N |
Cholestatic Hepatitis | Inc | N or Dec | Dec Dec | Inc Slight Inc | Inc |
Jaundice due to Cirrhosis | Inc | N or Inc | <1 indirect >1 direct | Inc Inc | |
Extrabiliary obstruction | Inc | Dec | Dec +++ Dec +++ | Inc N or Inc | Inc mild to moderate |
Inc = increased N = Normal Dec = Decreased
Diagnostic tests for various diseases of the liver:
Disease | Lab Tests | Interpretation |
Acute Viral Hepatitis | Bilirubin | raised (variable level) |
SGOT | raised 10 to 100 times the normal value | |
SGPT | raised 10 to 100 times the normal value | |
Gamma GT | raised 5 times the normal value | |
Viral markers | positive | |
Chronic hepatitis | SGPT | mildly raised |
SGOT | mildly raised | |
Bilirubin | persistently raised | |
Cirrhosis | SGPT | slightly raised |
SGOT | Slightly raised | |
Bilirubin | mildly raised | |
Alkaline phosphatase | mildly raised | |
Gamma GT | mildly raise | |
Prothrombin time | prolonged | |
Alcoholic liver | SGPT / SGOT | mildly raised |
Gamma GT | raised 2 to 3 times the normal value | |
Albumin | decreased | |
Globulin | raised | |
Primary biliary cirrhosis | Bilirubin | raised |
Alkaline phosphatase | raised 2 to 10 times the normal value | |
SGPT / SGOT | moderately raised | |
Liver malignant tumor | SGPT / SGOT | maybe raised |
Alkaline phosphatase | raised | |
Gamma GT | raised to 20 times the normal value | |
Cholestatic jaundice | Bilirubin | raised mostly conjugated |
Alkaline phosphatase | markedly raised | |
SGPT / SGOT | mildly raised | |
Gamma GT | markedly raised |
Lab tests in jaundice:
- Bilirubin direct and indirect:
- Direct bilirubin is increased in obstructive jaundice.
- Indirect bilirubin increased hemolytic jaundice and infections, and toxic hepatitis.
- Urobilinogen quantitative:
- Increased urobilinogen is seen in a liver infection, and toxic hepatitis is reabsorbed from the intestine.
- There is also an increase in the various types of hemolytic diseases.
- The absence of urobilinogen is strongly suggestive of posthepatic biliary obstruction.
- Urine bilirubin:
- There is an increase in the urine bilirubin due to the excessive production of bilirubin which is usually because of pf the posthepatic type.
- Fecal urobilin:
- The absence of urobilin (stercobilin) in the stool indicates that no bilirubin is not entering the duodenum. This will lead to a clay-colored stool.
- Alkaline phosphatase:
- It is increased in post-hepatic jaundice, cholangitis, and primary or metastatic cancer.
- There may be a mild increase in hepatic jaundice.
- Cholesterol esters:
- It is a decrease in liver disease.
- Response to vitamin K:
- A poor response to vitamin K is seen in liver disease.
- Flocculation test:
- Positive cephalin flocculation or thymol flocculation tests indicate liver diseases like infections or toxic hepatitis.
- Galactose tolerance test:
- There is decreased tolerance to galactose is found in liver disease.
- Liver needle biopsy:
- This will diagnose liver disease.
Diagnosis of Various Types of Jaundice:
Clinical condition | Urine bilirubin | Urine urobilinogen | Alk. Phosphatase | Bilirubin Direct | Bilirubin indirect | BSP test | Ceph. Flocculation |
Hepatitis with jaundice | Positive | Increased | Normal or slightly Increased | Normal or slightly increased | Increased | Increased retention | Positive |
Hepatitis without jaundice | ± | Increased | Normal | Normal | Normal | Increased retention | Positive |
Hemolytic jaundice | Negative | Increased | Normal | Normal | Increased | Normal | Negative |
Extrahepatic biliary obstruction | Positive | Decreased or absent | Increased | Increased | Normal | Not satisfactory | Negative |
Please see more details in the LFT.
Excellent D/D
Thanks for the appreciation.
Tnx, excellent work,. Go forward and write more and more
Thanks a lot for the encouraging remarks. We are trying our best to update all the subjects.
My nicee 9 yr old having direct bilirubin 0.3 and sgot 34 what could be the diagnosis
It is normal.