Overview
What causes conjugated hyperbilirubinemia?
Which diseases cause conjugated hyperbilirubinemia?
How is conjugated hyperbilirubinemia diagnosed?
What is the difference between direct and indirect bilirubin?
What is the role of the kidneys in the etiology of conjugated hyperbilirubinemia?
What are normal bilirubin levels?
What is the pathophysiology of conjugated hyperbilirubinemia?
What are the most common etiologies of conjugated hyperbilirubinemia?
What are the most common diseases that cause conjugated hyperbilirubinemia?
What is the prevalence of conjugated hyperbilirubinemia in the US?
What is the global prevalence of conjugated hyperbilirubinemia?
How does the prevalence of conjugated hyperbilirubinemia vary by sex and race?
How does the prevalence of conjugated hyperbilirubinemia vary by age?
What is the morbidity and the mortality associated with conjugated hyperbilirubinemia?
Presentation
What is the focus of clinical history in suspected conjugated hyperbilirubinemia?
What are risk factors for viral hepatitis-related conjugated hyperbilirubinemia?
What are the signs and symptoms of conjugated hyperbilirubinemia?
What are physical manifestations of conjugated hyperbilirubinemia?
Which findings of abdominal palpation suggest conjugated hyperbilirubinemia?
Which findings of biliary obstructions suggest conjugated hyperbilirubinemia?
Which physical findings suggest hemochromatosis?
Which findings may suggest a chronic alcoholism etiology for conjugated hyperbilirubinemia?
DDX
What is essential when diagnosing conjugated hyperbilirubinemia?
What are the differential diagnoses for Conjugated Hyperbilirubinemia?
Workup
Which lab studies are necessary for the diagnosis of conjugated hyperbilirubinemia?
What is the role of fractionated bilirubin levels in the diagnosis of conjugated hyperbilirubinemia?
When is a liver biopsy indicated for the diagnosis of conjugated hyperbilirubinemia?
How is biliary atresia diagnosed in patients with conjugated hyperbilirubinemia?
What is the role of ultrasonography in the diagnosis of conjugated hyperbilirubinemia?
What is the role of CT scanning in the diagnosis of conjugated hyperbilirubinemia?
What are the advantages of CT scanning for the diagnosis of conjugated hyperbilirubinemia?
What are the disadvantages of CT scanning for the diagnosis of conjugated hyperbilirubinemia?
What is the role of MRI in the diagnosis of conjugated hyperbilirubinemia?
What are the advantages of MRI for the diagnosis of conjugated hyperbilirubinemia?
What are the disadvantages of MRI for the diagnosis of conjugated hyperbilirubinemia?
What are the advantages of ERCP for the diagnosis of conjugated hyperbilirubinemia?
What are the disadvantages of ERCP for the diagnosis of conjugated hyperbilirubinemia?
Treatment
What are the treatment options for conjugated hyperbilirubinemia?
Which specialist consultations are needed for the management of conjugated hyperbilirubinemia?
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Conjugated Hyperbilirubinemia. This gross liver specimen from a patient with Dubin-Johnson syndrome shows multiple areas of dark pigmentation. Image courtesy of Cirilo Sotelo-Avila, MD.
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Conjugated Hyperbilirubinemia. The microscopic histologic image of the liver in Dubin-Johnson syndrome shows multiple areas of granulated pigment. Fontana Mason stain. Image courtesy of Cirilo Sotelo-Avila, MD.
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Conjugated Hyperbilirubinemia. This liver biopsy specimen demonstrates the ground-glass appearance of hepatocytes in a patient with hepatitis B.
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Conjugated Hyperbilirubinemia. A plain abdominal radiograph in a patient with a clinical diagnosis of acute cholecystitis is shown. The diagnosis was confirmed by means of abdominal ultrasonography. The radiograph shows faint opacities in the region of the gallbladder fossa (red circle) and dilated loops of small bowel in the epigastrium and midabdomen secondary to localized ileus.
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Conjugated Hyperbilirubinemia. A 26-year-old man known to be positive for human immunodeficiency virus (HIV) presented with pain in the right upper quadrant and mild jaundice. This 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.