What is the most likely diagnosis in a 25 year old male patient with jaundice and Serum Total bilirubin 21, in which direct is 9.6 and alkaline phosphatase 84 KA units?
Jaundice, or icterus is a yellowish discoloration of tissue resulting from the deposition of bilirubin. Tissue deposition of bilirubin occurs only in the presence of serum hyperbilirubinemia and is a sign of either liver disease or a hemolytic disorder. Hyperbilirubinemia may result from: ? Overproduction of bilirubin ? Impaired uptake, conjugation, or excretion of bilirubin ? Regurgitation of unconjugated or conjugated bilirubin from damaged hepatocytes or bile ducts The initial steps in evaluating the patient with jaundice are to determine whether the hyperbilirubinemia is predominantly conjugated or unconjugated in nature and whether other biochemical liver tests are abnormal. In obstructive jaundice there is a greater elevation of the alkaline phosphatase along with direct hyperbilirubinemia. Viral hepatitis and and drug induced hepatitis also causes cholestatic jaundice but does not increase alkaline phosphatase too much. Hemolytic jaundice causes indirect hyperbilirubinemia. Ref: Davidson's Principles and Practice of Medicine 19th Edition, Pages 844-845 ; Harrison's Internal Medicine, 18th Edition, Pages 324-29
Hemolytic anemia
Viral hepatitis
Drug induced hepatitis
Obstructive jaundice