A young male with gallbladder stones shows the following test results; serum bilirubin 2.5, Hb 6; urine test positive for urobilinogen; diagnosis is:
Answer is A (Haemolytic jaundice) All findings in the question corroborate with a haemolytic picture. Presence of Urobilinogen in urine rules out an obstructive cause for jaundice. Decrease in haemoglobin and elevated bilirubin levels are consistent with a haemolytic cause. Gall stones can be explained by precipitation of bilirubin (Bilirubinate crystals) Distinguishing features between various forms of Jaundice : Parameter Hemolytic Hepatocellular Obstructive Blood Blood Blood Blood Haemoglobin (12-18 g/dI) Unconjugated bilirubin (0.2 to 0.7 mg/dl) Conjugated bilirubin (0.1 to 0.3 mg/dl) Alkaline phosphatase (3-13 KAU) (30 to 120 IU/L) Aminotransferases . Cholesterol Decreased || N N N N N. N or | | N or | || N N. N | || N | Stool Stool Stool Stool Colour of stool N N Pale Urine Urine Urine Urine Bilirubin Urobilinogen 0 | | | | | Note : Gilbes Syndrome and Criggler Najjar syndrome: are enzyme disorders characterized by defective conjugation. They thus present with a picture similar to Hemolytic with the following exceptions: a. Hb is not decreased b.Urobilinogen is not increased (N or Rotor's syndrome and Dubin Johnson syndrome are characterized by defective excretion. They thus present with a picture similar to obstructive with the following exceptions: Alkaline phosphatase is not raised.
Hemolytic jaundice
Obstructive jaundice
Hepatocellular jaundice
Protoporphyria