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 ==


* Refers to a rise in ALP and GGT +/- bilirubin that is much more pronounced than any rise in ALT
* 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 ==
== Differential Diagnosis ==
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=== Marked Elevation ===
=== Marked Elevation ===


* Extrhepatic biliary obstruction
* ExtrAhepatic biliary obstruction
** [[Choledocholithiasis]]
** [[Choledocholithiasis]]
** Cancer of the [[Pancreatic cancer|pancreas]], gallbladder, ampulla of Vater, biliary duct, or perihilar lymph nodes
** Cancer of the [[Pancreatic cancer|pancreas]], gallbladder, ampulla of Vater, biliary duct, or perihilar lymph nodes
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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
** Infection: AIDS cholangiopathy, [[Ascaris lumbricoides]], [[liver fluke]]
** 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]]

== 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

Latest revision as of 18:53, 14 July 2024

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