Conjugated Hyperbilirubinemia Treatment & Management

  • Author: Richard A Weisiger, MD, PhD; Chief Editor: Julian Katz, MD   more...
 
Updated: Jan 5, 2012
 

Consultations

  • In most patients, the cause of conjugated hyperbilirubinemia is apparent, such as those with viral hepatitis or sepsis.
  • When this is not the case or when multiple causes are possible, consultation with a gastroenterologist or hepatologist may be helpful.
 
Contributor Information and Disclosures
Author

Richard A Weisiger, MD, PhD  Director, GI and Liver Faculty Practice, Professor, Department of Internal Medicine, University of California San Francisco

Richard A Weisiger, MD, PhD is a member of the following medical societies: American Association for the Study of Liver Diseases and American Society for Clinical Investigation

Disclosure: Nothing to disclose.

Specialty Editor Board

Vivek V Gumaste, MD  Associate Professor of Medicine, Mount Sinai School of Medicine of New York University; Adjunct Clinical Assistant, Mount Sinai Hospital; Director, Division of Gastroenterology, City Hospital Center

Vivek V Gumaste, MD is a member of the following medical societies: American College of Gastroenterology and American Gastroenterological Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Oscar S Brann, MD, FACP  Associate Clinical Professor, Department of Medicine, University of California at San Diego; Consulting Staff, Mecklenburg Medical Group

Oscar S Brann, MD, FACP is a member of the following medical societies: American Gastroenterological Association

Disclosure: Nothing to disclose.

Alex J Mechaber, MD, FACP  Senior Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine

Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD  Clinical Professor of Medicine, Drexel University College of Medicine

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

References

  1. Lathe GH. The degradation of haem by mammals and its excretion as conjugated bilirubin. Essays Biochem. 1972;8:107-48. [Medline].

  2. Muraca M, Fevery J, Blanckaert N. Analytic aspects and clinical interpretation of serum bilirubins. Semin Liver Dis. May 1988;8(2):137-47. [Medline].

  3. Westwood A. The analysis of bilirubin in serum. Ann Clin Biochem. Mar 1991;28 (pt 2):119-30. [Medline].

  4. Iyanagi T, Emi Y, Ikushiro S. Biochemical and molecular aspects of genetic disorders of bilirubin metabolism. Biochim Biophys Acta. Sep 30 1998;1407(3):173-84. [Medline].

  5. Klein CJ, Revenis M, Kusenda C, Scavo L. Parenteral nutrition-associated conjugated hyperbilirubinemia in hospitalized infants. J Am Diet Assoc. Nov 2010;110(11):1684-95. [Medline].

  6. Johnston DE. Special considerations in interpreting liver function tests. Am Fam Physician. Apr 15 1999;59(8):2223-30. [Medline]. [Full Text].

  7. Segal I, Rassekh SR, Bond MC, Senger C, Schreiber RA. Abnormal liver transaminases and conjugated hyperbilirubinemia at presentation of acute lymphoblastic leukemia. Pediatr Blood Cancer. Sep 2010;55(3):434-9. [Medline].

  8. Blanckaert N, Servaes R, Leroy P. Measurement of bilirubin-protein conjugates in serum and application to human and rat sera. J Lab Clin Med. Aug 1986;108(2):77-87. [Medline].

  9. Doumas BT, Wu TW. The measurement of bilirubin fractions in serum. Crit Rev Clin Lab Sci. 1991;28(5-6):415-45. [Medline].

  10. Faust TW, Reddy KR. Postoperative jaundice. Clin Liver Dis. Feb 2004;8(1):151-66. [Medline].

  11. Fevery J, Muraca M, Mesa V, et al. Plasma bilirubin pigments in health and disease. Mol Aspects Med. 1987;9(5):391-404. [Medline].

  12. [Best Evidence] Jangaard KA, Fell DB, Dodds L, Allen AC. Outcomes in a population of healthy term and near-term infants with serum bilirubin levels of >or=325 micromol/L (>or=19 mg/dL) who were born in Nova Scotia, Canada, between 1994 and 2000. Pediatrics. Jul 2008;122(1):119-24. [Medline].

  13. Jansen PL, Muller M. Early events in sepsis-associated cholestasis. Gastroenterology. Feb 1999;116(2):486-8. [Medline].

  14. Jedlitschky G, Leier I, Buchholz U, et al. ATP-dependent transport of bilirubin glucuronides by the multidrug resistance protein MRP1 and its hepatocyte canalicular isoform MRP2. Biochem J. Oct 1 1997;327 (pt 1):305-10. [Medline]. [Full Text].

  15. Kamisako T, Leier I, Cui Y, et al. Transport of monoglucuronosyl and bisglucuronosyl bilirubin by recombinant human and rat multidrug resistance protein 2. Hepatology. Aug 1999;30(2):485-90. [Medline]. [Full Text].

  16. Kirk JM. Neonatal jaundice: a critical review of the role and practice of bilirubin analysis. Ann Clin Biochem. Sep 2008;45:452-62. [Medline].

  17. Korenblat KM, Berk PD. Hyperbilirubinemia in the setting of antiviral therapy. Clin Gastroenterol Hepatol. Apr 2005;3(4):303-10. [Medline].

  18. McKiernan PJ. Neonatal cholestasis. Semin Neonatol. Apr 2002;7(2):153-65. [Medline].

  19. Mews C, Sinatra FR. Cholestasis in infancy. Pediatr Rev. Jun 1994;15(6):233-40; quiz 240. [Medline].

  20. Moyer V, Freese DK, Whitington PF, et al. Guideline for the evaluation of cholestatic jaundice in infants: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr. Aug 2004;39(2):115-28. [Medline].

  21. Muraca M, Fevery J, Blanckaert N. Relationships between serum bilirubins and production and conjugation of bilirubin. Studies in Gilbert's syndrome, Crigler-Najjar disease, hemolytic disorders, and rat models. Gastroenterology. Feb 1987;92(2):309-17. [Medline].

  22. Nowicki MJ, Poley JR. The hereditary hyperbilirubinaemias. Baillieres Clin Gastroenterol. Jun 1998;12(2):355-67. [Medline].

  23. Qualmann K, Rehage J, Scholz H. Measurement of bilirubin by HPLC in bovine plasma--a comparison with the conventional diazo-method. Dtsch Tierarztl Wochenschr. Sep 1997;104(9):354-8. [Medline].

  24. Roche SP, Kobos R. Jaundice in the adult patient. Am Fam Physician. Jan 15 2004;69(2):299-304. [Medline]. [Full Text].

  25. te Boekhorst T, Urlus M, Doesburg W, Yap SH, Goris RJ. Etiologic factors of jaundice in severely ill patients. A retrospective study in patients admitted to an intensive care unit with severe trauma or with septic intra-abdominal complications following surgery and without evidence of bile duct obstruction. J Hepatol. Aug 1988;7(1):111-7. [Medline].

  26. The familial conjugated hyperbilirubinemias. Semin Liver Dis. Nov 1994;14(4):386-94. [Medline].

  27. Venigalla S, Gourley GR. Neonatal cholestasis. Semin Perinatol. Oct 2004;28(5):348-55. [Medline].

  28. Zimniak P. Dubin-Johnson and Rotor syndromes: molecular basis and pathogenesis. Semin Liver Dis. Aug 1993;13(3):248-60. [Medline].

 
Previous
Next
 
Table 1
I. Acute or Chronic Hepatocellular DysfunctionII. Diseases That Prevent Flow of Bile into the Intestine
A. InfectionA. Damage to Intrahepatic Bile Ducts or Portal Tracts
Viral hepatitis A-ECytomegalovirus (CMV) hepatitisEpstein-Barr virus hepatitisSepsisPrimary biliary cirrhosis Graft versus host disease Veno-occlusive disease Sclerosing cholangitis
B. Inflammation Without InfectionB. Damage to or Obstruction of Larger Bile Ducts
Toxic liver injuryDrug toxicity (eg, acetaminophen)Halothane hepatitisAlcoholic hepatitisIron overload (hemochromatosis)Copper overload (Wilson disease)Autoimmune hepatitis Choledocholithiasis Sclerosing cholangitisAIDS cholangiopathyHepatic arterial chemotherapyPostsurgical stricturesBile duct cancersDevelopmental disorders of the bile ducts (eg, Caroli)Extrinsic compression of the bile ductTumorsAcute pancreatitis
C. Metabolic DysfunctionC. Diffuse Infiltrative Diseases
Ischemia ("shock liver")Acute fatty liver of pregnancyAlpha-1 antitrypsin deficiencyPreeclampsiaReye syndromeTotal parenteral nutrition Granulomatous diseasesSarcoidosisDisseminated mycobacterial infectionsLymphomaWegener granulomatosis Amyloidosis Diffuse malignancy
D. Inborn Errors of MetabolismD. Diseases That Interfere with Biliary Secretion of Bilirubin
Dubin-Johnson syndrome Rotor syndromeBenign recurrent cholestasisDrug-induced cholestasis, as with the following:- Chlorpromazine- Erythromycin- Estrogens- Anabolic steroids- Many others
Previous
Next
 
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.