antimitochondrial antibody positive: liver biopsy

In evaluating jaundice in patients with chronic hemolysis

High incidence of pigmented gallstones increase likelihood of choledocholithiasis

LABORATORY TESTS

Serum bilirubin

Van den Bergh method

Direct fraction provides approximate determination of conjugated bilirubin in serum

Total serum bilirubin is the amount that reacts after addition of alcohol

bilirubin that is covalently linked to albumin

Albumin linked bilirubin fraction represents important fraction of total serum bilirubin in
patients with cholestasis and hepatobiliary disorders.

Prolonged half-life of albumin-bound conjugated explains 2 previously unexplained

enigmas in jaundiced patients with liver disease

Some patients with conjugated hyperbilirubinemia do not exhibit bilirubinuria during

recovery phase of disease because bilirubin is bound to albumin and not filtered by
renal glomeruli

Elevated serum bilirubin level declines more slowly than expected in some patients
who otherwise appear to be often cause is viral hepatitis A

History - focus on medication/drug exposure

Physical examination

Laboratory tests (liver function test)

Total and direct bilirubins

Transaminases (AST, ALT)

Alkaline Phosphatase

Prothrombin Time

Albumin
If bilirubin and other liver tests are elevatedrecovering satisfactorily