Conjugated Hyperbilirubinemia Differential Diagnoses

Updated: Jul 31, 2019
  • Author: Richard A Weisiger, MD, PhD; Chief Editor: BS Anand, MD  more...
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DDx

Diagnostic Considerations

It is essential that clinicians determine the cause of, and treat, cholestasis, including mechanical obstruction of bile flow versus impaired excretion of bile components into the bile canaliculus, and intrahepatic versus extrahepatic etiologies. [8]

Consider the following conditions in the differential diagnosis of patients with suspected conjugated hyperbilirubinemia:

  • Cytomegalovirus (CMV) hepatitis

  • Drug toxicity, especially the following: acetaminophen, allopurinol, anabolic steroids, chlorpromazine, estrogens, halothane, isoniazid, methyldopa, phenytoin, protease inhibitors, quinidine, rifampicin, statins, and sulfa drugs

  • Exposure to environmental hepatotoxins (eg, beryllium, "nutraceuticals" [eg, herbal tea], organic solvents)

  • Acute fatty liver of pregnancy

  • Inherited disorders of bilirubin conjugation (eg, Rotor syndrome)

  • Liver congestion

  • Liver ischemia (shock liver)

  • Rejection of transplanted liver

  • Reye syndrome

  • Total parenteral nutrition (TPN) toxicity [9]

  • Veno-occlusive disease associated with chemotherapy

Differential Diagnoses