Elevated cholestatic liver enzymes: Difference between revisions
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=== Marked Elevation === |
=== Marked Elevation === |
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* |
* ExtrAhepatic biliary obstruction |
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** [[Choledocholithiasis]] |
** [[Choledocholithiasis]] |
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** 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 |
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*** 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]] |
** Infection: [[AIDS cholangiopathy]], [[Ascaris lumbricoides]], [[liver fluke]] |
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* Intrahepatic cholestasis |
* Intrahepatic cholestasis |
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** Drugs and toxins |
** Drugs and toxins |
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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
- ExtrAhepatic 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 complication of ERCP
- Chronic pancreatitis resulting in stricture of the distal bile duct
- Anastomotic stricture of the bile duct after liver transplantation
- Infection: AIDS cholangiopathy, Ascaris lumbricoides, liver fluke
- Intrahepatic cholestasis
- Drugs and toxins
- Primary biliary cholangitis
- Primary sclerosing cholangitis
- Intrahepatic cholestasis of pregnancy
- Benign postoperative cholestasis
- Total parenteral nutrition
- Infiltrative diseases: amyloidosis, lymphoma, sarcoidosis, tuberculosis, or hepatic abscess
- Liver metastases
- Allograft rejection after liver transplant
- Alcoholic hepatitis
- Hepatic crisis of sickle cell disease
- 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
