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 with elevated lipase
  • 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
  • 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