Differential diagnosis of jaundice

Determining the type of jaundice has undoubted importance for rational treatment of the patient (differential diagnosis of jaundice are shown in table).

Indicators Type of jaundice
hemolytic (nadrechenskaya) liver (gepatozellliarny) mechanical (obstructive)
History Similar diseases with relatives, jaundice for the first time in childhood, strengthening of jaundice after staying in the cold Contact with toxic substances, alcohol abuse; contact with sick with jaundice, infectious diseases (mononucleosis) Bouts of abdominal pain (with or without jaundice); re-hives; operations on bile ducts, dramatic weight loss
Color of skin Pale-yellow lemon shade Orange, yellow Yellow-grey, greenish
The intensity of jaundice Small Moderate From moderate to sharp
Skin itch No Unstable Sustainable
The severity of the liver No Often in the early stages of the disease Rarely, excluding the acute cholecystitis and echinococcosis
Pain in the liver No Rarely Often in the presence of stones or tumors
The size of the liver May be increased Increased, normal, reduced Increased *
The size of the spleen Increased Increased Generally not enlarged
Urine color Normal, maybe the dark (in the presence of urobilin) Dark (the presence of the conjugated bilirubin) Dark (the presence of the conjugated bilirubin)
The content of urobilin in urine Sharply increased You may not be short period, further excessively or moderately increased No if complete blockage
Color Kala Normal or dark (enhanced content stercobilin) Pale (reduced stercobilin, increased amount of fat) Pale (no stercobilin, increased amount of fat)
The functional liver samples The increase in the concentration of free bilirubin in the blood. Sedimentary reaction is negative. The activity of alkaline phosphatase not changed The increase in the concentration of bound and free bilirubin. Alkaline phosphatase activity is sometimes raised. Increased activity transaminaz. Sediment samples positive The high content of conjugated bilirubin in the blood. The increased activity of alkaline phosphatase. The elevated levels of cholesterol in the blood. Sediment samples negative
Special tests allowing to detect the type of jaundice Coombs Test. Determination of resistance of erythrocytes Liver biopsy. Laparoscopy. Radioisotope study with Bengal rose or colloidal gold. Bromsulfaleinovy sample The definition of occult blood in the stool. X-ray examination of the gastrointestinal tract and biliary tract. Liver biopsy. Percutaneous intrahepatic cholangiography. Laparoscopy. Scans of the liver
* Mechanical jaundice motivated tumor possible palpation enlarged gallbladder (sign Courvoisier-Terje).