作者：林德福
黃疸分類:
Isolated hyperbilirubinemia
- Unconjugated form (direct < 15%)
- Hemolysis (T.bil, LDH, Haptoglobin)
- Ineffective hematopoiesis (Thalassemia)
- Increased bilirubin production (Resorption of hematoma)
- Drugs: Rifampin, Probenecid, Ribavirin
- Inheritied: Gilbert’s, Crigler-Najjar
- Conjugated (direct > 15%)
- Inherited: Rotor’s, Dubin-Johnson
Hyperbilirubinemia with other liver test abnormalities.
- Hepatocellular conditions (often GPT > 5x)
- Viral hepatitis: (ALT > AST)
- Hepatitis A, B, C, D, E, EBV, CMV, HSV
- HAV-IgM, HBsAg, HBc-IgM, Anti-HCV
- Drug:
- Scanol, INH, Herbs
- Alcohol: (AST/ALT ≧ 2)
- Autoimmune: ANA, ASMA
- Metabolic: Wilson’s disease
- Ischemic hepatitis
- Cholestatic conditions (often ALP > 4x)
- Intrahepatic
- Drug: Contraceptive
- Primary biliary cirrhosis: AMA
- TPN, post-OP, sepsis.
- Extrahepatic
- Malignancy.
- CBD stone, Mirizzi syndrome
- Primary sclerosing cholangitis: p-ANCA
病史詢問
- Fatigue, nausea, vomiting.
- Abdominal pain, fever, weight loss.
- Dark urine or clay-colored stool
- Pruritus.
- IV, tattoos, or sexual exposure.
- Chemical or drug exposure.
- Travel history and contaminated food.
- Alcohol consumption
理學檢查
- RUQ tenderness.
- Stigmata of chronic liver disease.
- Virchow’s node
- Jugular vein
- Spleen
- Murphy’s sign
- Courvoisier’s sign
藥物
- Isolated hyperbilirubinemia: RIF, probenacid
Hepatocellular type
- Dose dependent: Acetaminophen
- Dose independent:
- Immunologic: Phenytoin, Sulfonamide, Methyldopa
- Idiosyncrasy: INH, Ketoconazole, TZD, NSAID.
Cholestatic type
- Steroids, contraceptive, chlorpromazine
中草藥及健康食品
