Specimen Name Result Units Range
Plasma Albumin 44 g/L (34-48)
Total Protein 65 g/L (60-80)
Total Bilirubin 124 μmol/L (6-24)
ALP 285 U/L (30-110)
ALT 305 U/L (< 55)
AST 400 U/L (< 45)

44yo obese female with severe upper abdominal pain.
Cholelithiasis
  • extra-hepatic obstructive jaundice
  • also had gallstone pancreatits
  • at risk for ascending cholangitis

 

Hyperbilirubinaemia - Predominantly Unconjugated

  1. Overproduction
    • haemolysis
    • reabsorption of haematoma
    • ineffective erythropoeisis
  2. Decreased hepatic uptake
    • sepsis
    • prolonged fasting
    • RV failure
    • drugs - rifampicin, probenecid
  3. Decreased conjugation
    • hepatocellular disease - hepatitis, cirrhosis
    • sepsis
    • drugs - chloramphenicol
    • inherited glucuronyl transferase deficiency
      • Gilbert's syndrome - actually ligandin deficiency
      • Crigler-Najjar - types II & I

Hyperbilirubinaemia - Predominantly Conjugated

  1. Biliary obstruction
    • biliary cirrhosis - primary | secondary
    • sclerosing cholangitis
    • extrahepatic obstruction - stone, tumour, stricture
  2. Impaired hepatic excretion
    • sepsis
    • post-operative state
    • hepatocellular disease
      • hepatitis - viral, ischaemic, drug-induced
      • cirrhosis
    • drug-induced cholestasis - OCP, methyltestosterone
    • inherited disorders
      • Dubin-Johnson, Rotor syndrome
      • benign familial cholestasis
    • cholestasis of pregnancy