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Jaundice, Excretion下降, normal ALT/ AST, abnormal ALT / AST, Chronic:…

- - - - Bilirubin elevation + others
        
        Hepatocellular（ALT/AST相比ALP明顯上升）
        
        Viral
        
        ANA,SMA,SPEP(+)
        
        毒物或藥物
        
        history / other tests
        
        Alcoholic liver disease
        
        AST>ALT (AST/ALT>2)
        
        AST, ALT<300U/L
        
        GGT>1000U/L
        
        Ultrasound
        
        Hepatosplenomegaly
        
        Fatty liver
        
        ALT>AST
        
        Posthepatic （ALP有明顯上升）
        
        Ultrasound
        
        膽道擴張
        
        MRCP
        
        Biopsy
        
        膽道沒擴張
        
        血清學
        
        AMA(+)
      - Isolated elevation of bilirubin
        
        Indirect (direct<15%)
        
        Inherited syndrome
        
        Gilbert's syndrome
        
        Crigler-Najjar syndrome
        
        Pre-hepatic
        
        Ineffecteive erythropoiesis
        
        Hemolytic disoder
        
        Drug
        
        Rifampin
        
        Probenecid
        
        Direct (direct >15%)
        
        Inherited disorder
        
        Dubin-Johnson syndrome
        
        Rotor symdrome
    - - color
        
        紅茶色
        
        Case3
        
        ultrasound
        
        biopsy
        
        Klatskin's tumor
      - mechanism
    - - colors
        
        灰白
      - mechanism
  - - - 腦病變
        
        語無倫次
  - - - CT
      - amylase elevation
        
        necrotic pancretits
      - lipase elevation
      - 冒冷汗
- - - - liver span
      - ascites
  - - - surgical incision
        
        history
      - superficial vein engorgement
        
        liver cirrhosis
    - - carotenoderma (no icteric sclera)
      - jaundice (with icteric sclera)
  - - - peritonitis
    - - cholecystitis
- - - - hepatic cause
        
        damage or obstruction of small bile duct
        
        toxin
        
        drugs
        
        unconjugated bilirubin 和 conjugated bilirubin都上升/黃疸合併深色尿液
        
        hepatitis
        
        viral infection
        
        cirrhosis
        
        metabolism
        
        Gilbert's syndrome
        
        cholestatic jaundice
  - - - hemolytic/pre-hepatic problem
        
        sickle cell crisis
        
        unconjugated bilirubin上升
        
        blood transfusion
        
        hemolytic drugs
        
        hemolytic anaemia