Last reviewed: 6 Oct 2024
Last updated: 24 Aug 2023
Summary
Definition
History and exam
Key diagnostic factors
- intermittent jaundice
- lack of pruritus
Full details
Other diagnostic factors
- illness, infection, or stress
- pregnancy-triggered jaundice
- medication-triggered jaundice
- abdominal pain
- fatigue
- hepatomegaly
Full details
Risk factors
- family history
- age 10 to 30 years
- Iranian Jewish or Moroccan Jewish ethnicity
- male sex
Full details
Diagnostic tests
1st tests to order
- serum bilirubin
- serum alkaline phosphatase
- serum liver aminotransferases (aspartate aminotransferase and alanine aminotransferase)
- serum albumin
- serum gamma-glutamyl transferase
- serum bile acids
- clotting profile
Full details
Tests to consider
- urinary coproporphyrin I to III ratio
- 99mTc hepatobiliary imino-diacetic acid (HIDA) scan (cholescintigraphy)
- liver biopsy
- mutational analysis of the ABCC2 gene
Full details
Emerging tests
- urinary leukotriene metabolites
Treatment algorithm
ACUTE
all patients
Contributors
Authors
Anil Dhawan, MBBS, MD, FRCPCH
Professor of Paediatric Hepatology
King's College Hospital
London
UK
Disclosures
AD declares he has no competing interests.
Tracy A.F. Coelho, MBBS, DCH, MRCPCH, PhD
Consultant Paediatric Gastroenterologist
University Hospital Southampton
Southampton
UK
Disclosures
TAFC declares that he has no competing interests.
Peer reviewers
John T. Jenkins, MB, CHB, FRCP
Consultant Surgeon
St. Mark's Hospital
London
UK
Disclosures
JTJ declares that he has no competing interests.
Nancy Reau, MD
Assistant Professor of Medicine
University of Chicago
Center for Liver Disease
Chicago
IL
Disclosures
NR has received reimbursement for speaking for Gilead, maker of Viread and Hepsera, and BMS, maker of Baraclude.
Differentials
- Rotor syndrome
- Gilbert syndrome
- Crigler-Najjar syndrome (type I & II)
More DifferentialsGuidelines
- ACR appropriateness criteria®: abnormal liver function tests
More Guidelines- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer