Unconjugated Mixed Conjugated

Hyperbilirubinemia Hyperbilirubinemia Hyperbilirubinemia

Hemolysis
RBC’s
Haptoglobin
LDH
Schistocytes +

Unconjugated Bili Unconjugated Bili

Unconjugated Bili

- Rifampin Unconjugated I. Bili

Bili + Conjugated Bili
Unconjugated Bili
UGT Hepatocellular
AST
Injury UGT
ALT +
UGT Gilbert’s +
- Disease D. Bili
+ Dark urine
Stress Conjugated Conjugated Bili
Conjugated Bili Bili
C. Bili
ALP -
Urobilinogen
GGT

Intrahepatic
Urobilinogen Transport Dysfunction ALP/GGT
Extrahepatic Dubin Johnson Syndrome
Rotor Syndrome
Portal
vein Intrahepatic Cholestasis
PBC
Dark urine C. Bili Urobilinogen Dark Urine C. Bili Urobilinogen
Urobilinogen
Cholestasis of Pregnancy
C. Bili Stercobilin
Pale stools Stercobilin Extrahepatic Cholestasis
Pale stools Stercobilin Pale stools +
Choledocholithiasis
PSC
Pancreatic tumor
 Tests for Hepatobiliary Injury Tests for Hepatic Function
Cirrhosis or Acute Liver Failure

Bilirubin
Albumin
Hepatocellular NH3
Injury
Hepatic Hepatic
Artery Oncotic TPO
Vein Pressure
Capillary Leakage
AST
Hepatocyte II/VII/IX/X, AT-III, C, S
ALT
Pleural Procoagulants
Effusion

Bile Duct Portal Vein PT/INR

Pitting Risk of
Edema Thrombocytopenia
Bleeding

Ascites

Coagulopathy
Cholestasis Hyperbilirubinemia
+ AST/ALT/ALP
-
ALP/
Bilirubin GGT Bilirubin (I. Bili)

Macrophage Unconjugated Bili

Mixed Bili
Intrahepatic UGT
Cholestasis Conjugated Bili

Bilirubin (D. Bili)

Extrahepatic
Cholestasis
 Hepatocellular Injury

Acute Elevation (> 1000) Vascular Dysfunction Chronic Elevation (< 500)
DILI (Tylenol) Ischemic Venous Congestion DILI (Alcohol) AST/ALT > 2
Vascular (Ischemic) Hepatitis CVP RHF
Viral (HAV, HEV, HBV) Clot Budd-Chiari Metabolic Diseases
Autoimmune Syndrome
BP NAFLD
Biliary Obstruction
(Shock) Wilson's
Hemochromatosis
O2

Viruses (HCV)

Cirrhosis

AST
ALT
Parenchymal Injury
ALP/GGT
Bilirubin Drug Induced
Tylenol > 4g/D
Alcohol
Biliary Obstruction
Bile Duct Metabolic Disease
Choledocholithiasis
Hemochromatosis Fe
Cholangitis
Wilsons Dx Cu
(Ascending)
A1AT
NAFLD Metabolic Syndrome

Autoimmune Hepatitis
ANA
ASMA*
IgG
Anti-LKM1
 Cholestasis

Bilirubin ALP GGT

Intrahepatic Cholestasis
Cholestasis of Pregnancy*
Bilirubin Estrogen
Medications (OCP’s)
PBC (AMA + )*
Bili Infiltrative Disease
ALP
+ GGT
Bile

Extrahepatic Cholestasis (Ductal Dilation)

Choledocholithiasis (Stone)
PSC (Strictures)
Pancreatic Carcinoma (Tumor)