Abdominal exam demonstrates a soft nontender abdomen without organomegaly and no ascites and no ankle edema. He has no scleral icterus and normal cardiovascular and respiratory systems. In a few instances, more invasive procedures such as cholangiography or liver biopsy may be needed to arrive at a diagnosis. The positive and negative predictive values of the Kings College Criteria for mortality in patients with. If the complete blood count and initial tests for liver function and infectious hepatitis are unrevealing, the work-up typically proceeds to abdominal imaging by ultrasonography or computed tomographic scanning. The laboratory work-up should begin with a urine test for bilirubin, which indicates that conjugated hyperbilirubinemia is present. The diagnosis of G6PD deficiency is made by a quantitative spectrophotometric analysis or, more commonly, by a rapid fluorescent spot test detecting the generation of NADPH from NADP.
Once HBeAg is negative and HBeAb is positive, HBsAg should be monitored periodically to determine viral clearance. Gallstone formation is the most common and benign posthepatic process that causes jaundice however, the differential diagnosis also includes serious conditions such as biliary tract infection, pancreatitis, and malignancies. Scleral icterus: Vascular spiders (spider telangiectasias, spider angiomata). Posthepatic disorders also can cause conjugated hyperbilirubinemia. Deposition of bilirubin happens only when there is an excess of bilirubin, a sign of increased production or impaired excretion. The conjugated (direct) bilirubin level is often elevated by alcohol, infectious hepatitis, drug reactions, and autoimmune disorders. Jaundice, also known as hyperbilirubinemia, 1 is a yellow discoloration of the body tissue resulting from the accumulation of an excess of bilirubin. Intrahepatic disorders can lead to unconjugated or conjugated hyperbilirubinemia. Scleral icterus is a misnomer-seriously And thats just the first pearl in this post about hyperbilirubinemia. Prehepatic causes of jaundice include hemolysis and hematoma resorption, which lead to elevated levels of unconjugated (indirect) bilirubin. Atazanavir tested positive in an in vitro clastogenicity test using.
Organizing the differential diagnosis by prehepatic, intrahepatic, and posthepatic causes may help make the work-up more manageable. The most common adverse reactions are nausea, jaundice/scleral icterus, and rash. Jaundice in an adult patient can be caused by a wide variety of benign or life-threatening disorders.
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