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Liver Function Tests:- Part 3 – Differential Diagnosis of Jaundice

Liver Function Tests:- Part 3 – Differential Diagnosis of Jaundice
December 5, 2021Chemical pathologyLab Tests

Liver function tests

Differential diagnosis of jaundice

Sample

  1. The serum of the patient is needed.
  2. 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 in 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:

  1. Bilirubin direct and indirect:
    1. Direct bilirubin is increased in obstructive jaundice.
    2. Indirect bilirubin is increased in hemolytic jaundice and infections, and toxic hepatitis.
  2. Urobilinogen quantitative:
    1. Increased urobilinogen is seen in an infection of the liver, and toxic hepatitis is reabsorbed from the intestine.
    2. There is also an increase in the various types of hemolytic diseases.
    3. The absence of urobilinogen is strongly suggestive of posthepatic biliary obstruction.
  3. Urine bilirubin:
    1. There is an increase in the urine bilirubin is due to the excessive production of bilirubin and is usually because of pf the posthepatic type.
  4. Fecal urobilin: 
    1. 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.
  5. Alkaline phosphatase:
    1. It is increased in post hepatic jaundice, cholangitis, and primary or metastatic cancer.
    2. There may be a mild increase in hepatic jaundice.
  6. Cholesterol esters:
    1. It is a decrease in liver disease.
  7. Response to vitamin K:
    1. A poor response to vitamin K is seen in liver disease.
  8. Flocculation test:
    1. Positive cephalin flocculation or thymol flocculation tests indicate liver diseases like infections or toxic hepatitis.
  9. Galactose tolerance test:
    1. There is decreased tolerance to galactose is found in liver disease.
  10. Liver needle biopsy:
    1. 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.


Possible References Used
Go Back to Chemical pathology

Comments

Dr zafar Reply
April 21, 2020

Excellent D/D

Dr. Riaz Reply
April 21, 2020

Thanks for the appreciation.

r.n.kothalawala Reply
July 31, 2020

Tnx, excellent work,. Go forward and write more and more

Dr. Riaz Reply
July 31, 2020

Thanks a lot for the encouraging remarks. We are trying our best to update all the subjects.

Mumtaz Reply
October 14, 2020

My nicee 9 yr old having direct bilirubin 0.3 and sgot 34 what could be the diagnosis

Dr. Riaz Reply
October 16, 2020

It is normal.

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