D.D. :
PHYSIOLOGICAL INCREASE :
- NEWBORN JAUNDICE
- PREGNANCY ( ONLY SMALL INCREASE)
- SEVERE EXERCISE
- ADAPTATION AT HIGH ALTITUTE
PATHOLOGICAL INCREASE :
A. PREHEPATIC HYPERBILIRUBINAEMIA
* INEFFECTIVE ERYTHROPOIESIS E.G. PERNICIOUS ANEMIA
* POST TRANSFUSION OF STORED BLOOD
* DUE TO EXCESSIVE HAEMOLYSIS
1. DUE TO INTRINSIC CELL DEFECTS
* HAEMOGLOBINOPATHIES LIKE
- SICKLE CELL ANEMIA
- BETA- THALASSAEMIA MAJOR
* HEREDITARY SPHEROCYTOSIS
* HEREDITARY ELLIPTOCYTOSIS
* RED CELL ENZYME DEFECTS LIKE
- G-6 PD DEFICIENCY
- PYRUVATE KINASE DEFICIENCY
- PAROXYSMAL NOCTURNAL HAEMOGLOBINURIA
- SPUR CELL ANEMIA
3. EXTRINSIC FACTORS
A. HYPERSPLENISM
B. ANTIBODIES : IMMUNE HEMOLYSIS
1. WARM ANTIBODY IMMUNOHEMOLYTIC ANEMIA
* IDIOPATHIC
* LYMPHOMAS LIKE CHR LYMPHOCYTIC LEUKEMIA, NON HODGKINS LYMPHOMAS, HODGKINS DISEASE
* SLE & OTHER COLLAGEN VASCULAR DISEASES
* DRUGS LIKE METHYLDOPA, PENICILLIN, QUINIDINE TYPES
* POST VIRAL INFECTIONS
* OTHER TUMORS ( RARE )
2. COLD ANTIBODY IMMUNOHEMOLYTIC ANEMIA
* IDEOPATHIC
* IN ASSOCIATION WITH DISEASES LIKE MYCOPLASMA INFECTION, INFECTIOUS MONONUCLEOSIS & HISTIOCYTIC LYMPHOMA
* PAROXYSMAL COLD HEMOGLOBINURIA
C. NON-IMMUNE OR MICROANGIOPATHIC HEMOLYSIS ASSOCIATED WITH FIBRIN DEPOSITION & MECHANICAL DAMAGE TO RBC
D. INFECTIONS LIKE MALARIA, CLOSTRIDIUM WELCHII SEPTICAEMIA, GRAM NEGATIVE SEPTICAEMIA LEADING TO DIC
* VALVE PROSTHESES
* TOXINS ETC
B. HEPATIC HYPERBILIRUBINAEMIA
DUE TO SPECIFIC DEFECTS
1. DECREASED UPTAKE
* GILBERTS DISEASE
* SEVERE CARDIAC FAILURE
* PORTACAVAL SHUNT
* ANTITUBERCULAR DRUGS LIKE RIFAMPICIN
2. IMPAIRED HEPATIC CONJUGATION
* CRIGLER- NAJJAR SYNDROME
3. DEFECTIVE TRANSFER OF CONJUGATED BILIRUBIN
* DUBIN - JOHNSON SYNDROME
* ROTOR SYNDROME
* SYNTHETIC ANDROGENS & OESTROGENS
GENERALISED HEPATIC DYSFUNCTION
1. AC LIVER DAMAGE OF INFECTIVE ORIGIN
* HEPATITIS TYPE A,B,C & DUE TO DELTA & OTHER VIRUSES
* YELLOW FEVER
* INFECTIOUS MONONUCLEOSIS ( MILD )
* SYSTEMIC INFECTION WITH RICKETTSIAL, FUNGAL & MYCOPLASMA ORGANISMS
* SEPTICAEMIA
2. AC LIVER DAMAGE FROM DRUGS, CHEMICALS & TOXINS
* MAO INHIBITORS, PAS, HALOTHANE, TRICYCLIC ANTIDEPRESSANTS, PHENOTHIAZINES, BENZODIAZEPINES, ORAL HYPOGLYCAEMICS, METHYLDOPA, ISONIAZID, RIFAMMPICIN.
* CHEMICALS LIKE CHLORINATED HYDROCARBONS LIKE TRICHLOROETHYLENE, CARBON TETRACHLORIDE, DDT, PHOSPHORUS, IRON, ALCOHOL, ETHANOL
* TOXINS LIKE MYCOTOXINS FROM AMANITA PHALLOIDES & AFLATOXIN PRESENT IN FOOD CONTAMINATED WITH ASPERGILLUS SPECIES.
3. OTHER CAUSES LIKE
* AC FATTY LIVER OF PREGNANCY
* AC LEFT VENTRICULAR FAILURE
CHRONIC LIVER DAMAGE
* LIVER CIRRHOSIS
* PRIMARY BILIARY CIRRHOSIS
* CHR ACTIVE HEPATITIS
* ALCOHOL
* WILSONS DISEASE
* HAEMOCHROMATOSIS
* ALPHA-1 ANTITRYPSIN DEFICIENCY
* CRYPTOGENIC
* PRIMARY OR SEC LIVER TUMORS
* GRANULOMATOUS DISEASES LIKE TUBERCULOSIS, LEPROSY
* INFILTRATIVE DISORDERS LIKE SARCOIDOSIS
C. POST HEPATIC HYPERBILIRUBINAEMIA
1. INTRAHEPATIC CHOLESTASIS
* PRIMARY BILIARY CIRRHOSIS & OTHER CAUSES OF CIRRHOSIS
* BENIGN RECURRENT INTRAHEPATIC CHOLESTASIS
* PROGRESSIVE FAMILIAL INTRAHEPATIC CHOLESTASIS
* SOME CASES OF VIRAL HEPATITIS
2. EXTRAHEPATIC CHOLESTASIS
* BILE DUCT OBSTRUCTION DUE TO
- GALL STONES
- PARASITES LIKE ASCARIASIS, OPISTHORUS TENNICOLLIS, CLONORCHIS SINENSIS
- BILIARY ATRESIA
- BILE DUCT CARCINOMA
- CARCINOMA OF HEAD OF PANCREAS OR AMPULLA OF VATER
- CICATRICIAL CONTRACTION OF BILE DUCT SYSTEM IN CHR PANCREATITIS
- RARELY PERITONEAL ADHESIONS, ENLARGED PROTAL LYMPH NODES & HEPATIC ARTRY ANEURYSM, HYADATID CYST, RETROPERITONEAL CYSTS OR TUMORS, DUODENAL DIVERTICULUM, MIRIZZI SYNDROME