Differential diagnosis of jaundice

What sample is needed for the liver function test?

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.

 What is the differential diagnosis of jaundice and LFT?

Disease	Urine		Stool	Serum  Bilirubin	Serum cholesterol
Tests	Bilirubin	Urobilinogen	Bilirubin          Urobilinogen	Direct                  Indirect	Cholesterol
Viral Hepatitis	Increased	Normal or Increased	Decreased        Decreased	Increased            Increased	Normal or   Increased
Hepatitis due to drugs	Inc	N or Inc	Decreased       Decreased	Increased          Increased	Normal
Cholestatic Hepatitis	Inc	N or Dec	Decreased       Decreased	Increased       Slight Inc	Increased
Jaundice due to Cirrhosis	Inc	N or Inc	<1 indirect         >1 direct	Increased       Increased
Extrabiliary obstruction	Increased	Decreased	Decreased +++ Dec +++	Increased        N or Inc	Inc mild to moderate

Inc = increased     N = Normal     Dec = Decreased

What are the diagnostic tests for various liver diseases?

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

What are the Lab tests for jaundice?

1. Bilirubin direct and indirect:
   1. Direct bilirubin is increased in obstructive jaundice.
   2. Indirect bilirubin increased in hemolytic jaundice, infections, and toxic hepatitis.
2. Urobilinogen quantitative:
   1. Increased urobilinogen is seen in a liver infection, and toxic hepatitis is reabsorbed from the intestine.
   2. There has also been an increase in 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 urine bilirubin due to the excessive production of bilirubin, which is usually due to the posthepatic type.
4. Fecal urobilin: 
   1. The absence of urobilin (stercobilin) in the stool indicates that no bilirubin enters the duodenum, leading 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, which is found in liver disease.
10. Liver needle biopsy:
    1. This will diagnose liver disease.

How will you diagnose 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

What is the differential diagnosis of increased serum bilirubin?

Please see more details in the LFT.

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