Laboratory Evaluation of the patient with jaundice

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Evaluation of the Patient with cirrhosis

Disease Tests and findings

Alcoholic liver disease History of alcohol abuse

AST/ALT > 2 with both being less than 500 IU/mL if alcoholic hepatitis is present.

Chronic hepatitis C Second generation assay for anti-HCV

PCR for HCV RNA if confirmatory test is necessary.

Primary biliary cirrhosis Antimitochondrial antibodies as an isolated finding

Primary sclerosing cholangitis Strong association with inflammatory bowel disease


Contrast cholangiography to establish the diagnosis

Antinuclear and antismooth muscle antibodies

and

ANCA; these are not diagnostic

Autoimmune hepatitis Hypergammaglobulinemia

Antinuclear and antismooth muscle antibodies and ANCA in type 1; anti-LKM-1 in type 2.

Chronic hepatitis B HBsAg and HBeAg and, in some cases, HBV DNA by hybridization or bDNA assay.

Hereditary hemochromatosis Family history of cirrhosis

Transferrin saturation and plasma ferritin should be performed but may be elevated by liver disease itself.

Diagnosis established by liver biopsy and calculation of hepatic iron index or by genetic testing.

Wilson's disease Family or personal history of cirrhosis at a young age

Serum ceruloplasmin reduced in 95 percent of patients.

Liver biopsy shows increased copper content which may also be seen in cholestatic liver diseases.

Alpha-1-antitrypsin deficiency Family or personal history of cirrhosis at a young age

Serum AAT; phenotyping if low or border line values.

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