Diagnostic approach to patients with cholestatic jaundice

a p h y , X -r a y c o m p u t e d ; ultrasonography Conjugated hyperbilirubinemia due to any form of hepatobiliary disease is essentially the result of impairment in bile formation and/or bile flow, a condi tion known as cholestasis [1,2] .Cholestatic jaundice is often accompanied by a broad spectrum of laboratory, clinical, and histological abnormalities.Laboratory abnormalities include increased serum levels of alkaline phosphatase and gamma-glutamyltransferase (GGT), and variable elevation of bilirubin, serum copper, ceruloplasmin, cholesterol, lipoprotein X, and serum bile acids, as well as of prothrombin time, which is corrected by vitamin K supplementation.T h e r e i s m i n i m a l o r n o e l e v a t i o n o f aminotransferases.Clinically, pruritus, fatigue, xanthomas, back pain from osteoporosis, pale stools, or even steatorrhea may be present, with evidence of fat-soluble vitamin deficiency.Histologically, conjugated hyperbilirubinemia is characterized by bile plugs (bilirubinostasis), feathery degeneration of hepatocytes (cholate stasis), small-bile-duct destruction, perich olangitis, portal edema, bile lakes and infarcts (typically with extrahepatic obstruction), and finally, biliary cirrhosis [1][2][3] .