Copyright
©The Author(s) 1999.
World J Gastroenterol. Jun 15, 1999; 5(3): 252-262
Published online Jun 15, 1999. doi: 10.3748/wjg.v5.i3.252
Published online Jun 15, 1999. doi: 10.3748/wjg.v5.i3.252
Table 1 Differential diagnosis of cholestasis and hyperbilirubinemia (cholestatic jaundice)
CBD dilated: Best approach is anatomically |
Ampulla of Vater |
Stones, carcinoma of pancreas, chronic pancreatitis, ampullary neoplasm, diverticulum, pancreatic cyst, abscess of pancreas, sphincter of Oddi dysfunction |
Common bile duct |
Benign traumatic stricture, stones, choledochal cyst, cholangiocarcinoma, parasites, hemobilia, extrahepatic atresia |
Gallbladder |
Carcinoma of gallbladder |
Portal nodes |
Cholangicarcinoma, lymphoma, metastatic carcinoma, cavernous portal vein |
Table 2 (continued): Differential diagnosis of cholestatic jaundice
Normal CBD |
Extrahepatic |
Stone too early, stone too late, cholangiocarcinoma, and primary sclerosing cholangitis |
Intrahepatic |
Intrinsic diseases |
Drugs, alcoholic hepatitis, viral hepatitis, AIDS, primary biliary cirrhosis, autoimmune cholangitis, primary sclerosing cholangitis, idiopathic adulthood ductopenia, Autoimmune hepatitis, decompensated liver cirrhosis |
Infiltrative diseases |
Granulomatous hepatitis (Tuberculosis, amyloidosis), sarcoidosis, Lymphoma, leukemia, fatty liver |
Systemic diseases |
Sepsis, total parenteral nutrition (TPN), benign recurrent intrahepatic cholestasis (BRIC), cholestasis of pregnancy, cystic fibrosis, disappearing intrahepatic ducts syndrome, allograft rejection, graft versus host disease (GVHD), sickle cell syndrome, mastocytosis, hypereosinophilic syndrome, Hyperthyroidism |
Space occupying lesions |
Blood-hematoma, peliosis; pus-bacterial, amebic; cyst-hydatid, polycystic Cancer-primary, secondary |
Table 3 Common drugs known to cause cholestatic jaundice
Antimicrobial agents |
Augmentin (amoxicillin-clavulanic acid), cloxacillin, erythromycin, ethambutol, dapsone, fluconazole, nitrofurantoin, griseofulvin, ketoconazole, terbinafine |
Cardiovascular agents |
Disopyramide beta-blockers, ACE inhibitors, propafenone, ticlopidine, warfarin, methyldopa |
Endocrine agents |
Sulfonylureas, clofibrate, estrogens, tamoxifen, androgens, niacin, oral contraceptives |
Gastrointestinal agents |
H2 blockers (e.g., ranitidine), penicillamine |
Immunosuppressive agents |
Azathioprine, cyclosporine, gold salts, NSAIDs (e.g. diclofenac, nimesulide, piroxicam) |
Psychopharmacologic agents |
Tricyclic antidepressants, benzodiazepines, phenothiazines, phenytoin, halothane |
Table 4 Causes and syndromes of ductopenia in the adult patient
Syndromatic ductopenia (Alagille syndrome) |
Non-syndromatic adult ductopenia |
Ductal plate malformation (congenital hepatic fibrosis, biliary atresia |
Primary biliary cirrhosis, autoimmune cholangitis |
Primary sclerosing cholangitis |
Chronic rejection |
Graft-versus-host disease |
Sarcoidosis |
Cystic fibrosis |
Byler disease (progressive familial intrahepatic cholestasis) |
Histiocytosis X and |
Different drugs (amoxicillin-clavulanic acid, carbamazepine) |
Duct destruction after regional chemotherapy (e.g. floxuridine) |
Idiopathic adulthood ductopenia |
- Citation: Assy N, Jacob G, Spira G, Edoute Y. Diagnostic approach to patients with cholestatic jaundice. World J Gastroenterol 1999; 5(3): 252-262
- URL: https://www.wjgnet.com/1007-9327/full/v5/i3/252.htm
- DOI: https://dx.doi.org/10.3748/wjg.v5.i3.252