Elevated cholestatic liver enzymes: Difference between revisions

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(Created page with "== Background == * Refers to a rise in ALP and GGT +/- bilirubin that is much more pronounced than any rise in ALT == Differential Diagnosis == === Marked Elevation === * Extrhepatic biliary obstruction ** Choledocholithiasis ** Cancer of the pancreas, gallbladder, ampulla of Vater, biliary duct, or perihilar lymph nodes ** Biliary strictures *** Primary sclerosing cholangitis with extrahepatic bile duct stricture *** Procedural complica...")
 
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== Background ==
 
== Background ==
   
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* Refers to a rise in ALP and GGT +/- bilirubin that is much more pronounced than any rise in ALT
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* Refers to a rise in [[ALP]] and [[GGT]] +/- bilirubin that is much more pronounced than any rise in ALT
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* [[ALP]] can also come from bone and placenta
   
 
== Differential Diagnosis ==
 
== Differential Diagnosis ==
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*** [[Chronic pancreatitis]] resulting in stricture of the distal bile duct
 
*** [[Chronic pancreatitis]] resulting in stricture of the distal bile duct
 
*** Anastomotic stricture of the bile duct after liver transplantation
 
*** Anastomotic stricture of the bile duct after liver transplantation
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** Infection: AIDS cholangiopathy, [[Ascaris lumbricoides]], [[liver fluke]]
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** Infection: [[AIDS cholangiopathy]], [[Ascaris lumbricoides]], [[liver fluke]]
 
* Intrahepatic cholestasis
 
* Intrahepatic cholestasis
 
** Drugs and toxins
 
** Drugs and toxins
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** Hepatic crisis of sickle cell disease
 
** Hepatic crisis of sickle cell disease
 
** Others: IgG4 cholangiopathy, ischemic cholangiopathy, [[COVID-19]]
 
** Others: IgG4 cholangiopathy, ischemic cholangiopathy, [[COVID-19]]
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== Investigations ==
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* Liver/biliary ultrasound to help differentiate between extrahepatic cholestasis (if biliary dilatation is seen) versus intrahepatic
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* For intrahepatic cholestasis
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** First order AMA (for PBC), ANA, anti-smooth muscle antibodies
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** Then consider MRCP, hepatitis A, B, C, and E testing, and EBV and CMV testing
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** Finally, consider liver biopsy

Revision as of 10:43, 13 July 2022

Background

  • Refers to a rise in ALP and GGT +/- bilirubin that is much more pronounced than any rise in ALT
  • ALP can also come from bone and placenta

Differential Diagnosis

Marked Elevation

Investigations

  • Liver/biliary ultrasound to help differentiate between extrahepatic cholestasis (if biliary dilatation is seen) versus intrahepatic
  • For intrahepatic cholestasis
    • First order AMA (for PBC), ANA, anti-smooth muscle antibodies
    • Then consider MRCP, hepatitis A, B, C, and E testing, and EBV and CMV testing
    • Finally, consider liver biopsy