Icterus

Question 1

What are your differentials for prehepatic hyperbilirubinemia?

Answer 1

(Prehepatic = excessive RBC destruction → immune-mediated, toxin, and post-transfusion)

Question 2

You have a patient that has hyperbilirubinemia and is icteric, what on your CBC might indicate it is prehepatic?

Answer 2

(Anemia)

Question 3

What are some of the causes of hepatic hyperbilirubinemia?

Answer 3

(Toxicity, hepatitis, cirrhosis (rare), end-stage portosystemic shunts, microvascular dysplasia, secondary injury (such as hepatic lipidosis), and congenital deficiencies (such as copper storage dz))

Question 4

What are some of the causes of post-hepatic hyperbilirubinemia?

Answer 4

(Biliary obstruction → gallbladder mucocele, cholelithiasis, pancreatitis, and tumors)

Question 5

You have a patient that is icteric so obviously you run blood work and note hyperbilirubinemia and elevated ALT and AST values, is it prehepatic, hepatic, or post-hepatic?

Answer 5

(Hepatic, this would have just given it away but would probably also see decreased pseudofunction analytes (glucose, BUN, cholesterol, albumin))

Question 6

You have a patient that is icteric so obviously you run blood work and note hyperbilirubinemia and elevated ALP values, is it prehepatic, hepatic, or post-hepatic and what further diagnostics might be especially helpful in confirming it?

Answer 6

(Post-hepatic, and ultrasound is good for post hepatic as you can look for a distended common bile duct)