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Conjugated Hyperbilirubinemia Treatment & Management

  • Author: Richard A Weisiger, MD, PhD; Chief Editor: BS Anand, MD  more...
 
Updated: Jan 05, 2016
 

Approach Considerations

Failure to diagnose liver toxicity due to ongoing drug or toxin exposure may lead to liver failure and death. For this reason, it is best to stop all potentially hepatotoxic drugs until the cause of the conjugated hyperbilirubinemia can be determined.

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 Emeritus Professor, Department of Internal Medicine, University of California, San Francisco, School of Medicine

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

Disclosure: Nothing to disclose.

Chief Editor

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Acknowledgements

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 at Elmhurst; Program Director of GI Fellowship (Independent Program); Regional Director of Gastroenterology, Queens Health Network

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

References
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Gross liver specimen from a patient with Dubin-Johnson syndrome showing multiple areas of dark pigmentation. Image courtesy of Cirilo Sotelo-Avila, MD.
Microscopic histology of the liver in Dubin-Johnson syndrome showing multiple areas of granulated pigment. Fontana Mason stain. Image courtesy of Cirilo Sotelo-Avila, MD.
Liver biopsy specimen showing ground-glass appearance of hepatocytes in a patient with hepatitis B.
Plain abdominal radiograph in a patient with a clinical diagnosis of acute cholecystitis. The diagnosis was confirmed by means of abdominal ultrasonography. The radiograph shows faint opacities in the region of the gallbladder fossa and dilated loops of small bowel in the epigastrium and midabdomen secondary to localized ileus.
A 26-year-old man known to be human immunodeficiency virus (HIV) positive presented with pain in the right upper quadrant and mild jaundice. Axial sonogram through the gallbladder (GB) and pancreas (P) shows sludge within the gallbladder and the lower common bile duct (arrow). A diagnosis of acalculous cholecystitis was confirmed. A = aorta; IVC = inferior vena cava; S = splenic vein.
Table. Differential Diagnosis of Conjugated Hyperbilirubinemia
I. Acute or Chronic Hepatocellular Dysfunction II. Diseases That Prevent Flow of Bile into the Intestine
A. InfectionA. Damage to Intrahepatic Bile Ducts or Portal Tracts
Viral hepatitis A-E



Cytomegalovirus (CMV) hepatitis



Epstein-Barr virus hepatitis



Sepsis



Primary 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 injury



Drug toxicity (eg, acetaminophen)



Halothane hepatitis



Alcoholic hepatitis



Iron overload (hemochromatosis)



Copper overload (Wilson disease)



Autoimmune hepatitis



Choledocholithiasis



Sclerosing cholangitis



AIDS cholangiopathy



Hepatic arterial chemotherapy



Postsurgical strictures



Bile duct cancers



Developmental disorders of the bile ducts (eg, Caroli)



Extrinsic compression of the bile duct



Tumors



Acute pancreatitis



C. Metabolic DysfunctionC. Diffuse Infiltrative Diseases
Ischemia ("shock liver")



Acute fatty liver of pregnancy



Alpha-1 antitrypsin deficiency



Preeclampsia



Reye syndrome



Total parenteral nutrition



Granulomatous diseases



Sarcoidosis



Disseminated mycobacterial infections



Lymphoma



Wegener granulomatosis



Amyloidosis



Diffuse malignancy



D. Inborn Errors of MetabolismD. Diseases That Interfere with Biliary Secretion of Bilirubin
Dubin-Johnson syndrome



Rotor syndrome



Benign recurrent cholestasis



Drug-induced cholestasis, as with the following:



- Chlorpromazine



- Erythromycin



- Estrogens



- Anabolic steroids



- Many others



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