Urine Analysis and Blood Testing for Jaundice

Urine Analysis and Blood Testing

It is the most simple test for the diagnosis of raised bilirubin levels. The findings of urine analysis should be confirmed by measurements of the serum total and direct bilirubin levels. 

Blood testing.

Blood testing in a patient presenting with jaundice include : 

1. Complete blood count ( CBC) and peripheral smear examination can detect haemolysis. This is indicated by the presence of broken red blood cells and increased reticulocytes. 

2. Liver function tests 

Determination of bilirubin ( total and direct fractions)
Aspartate transaminase ( AST)/SGOT
Alanine transaminase (ALT)/(SGPT)
Gamma-glutamyl transpeptidase
Alkaline phosphatase levels. 

AST and ALT are markers of hepatocellula injury. Acute viral Hepatitis may cause the levels of ALT to rise several thousand units per litre. They are less helpful in patients with chronic liver disease, because levels can be normal or only slightly elevated. 
Patients with acute alcoholic Hepatitis have AST and ALT levels that rise to several hundred units per litre. With alcohol induced damage, the ratio of AST to ALT is usually greater than 1, whereas infectious causes of Hepatitis typically cause greater elevation in ALT than in AST. 

Alkaline phosphatase and gamma-glutamyltranslferase are markers for obstruction to flow of bile. As bile obstruction progresses, the level of these enzymes rise several times above normal. 

Immunological Tests : These are tests for Hepatitis A 1g M antibody, Hepatitis B surface antigen ( HBs
Ag, Australia Antigen) and core antibody, Hepatitis C antibody, and autoimmune markers such as antinuclear, smooth muscle, and liver-kidney microsomal antibodies. 

Serum Amylase Levels : An elevated amylase level would corroborate the presence of pancreatitis when this condition is suspected based on history or physical examination. 

Ultrasonography : Ultrasonography is a simple, safe, and readily available test that uses sound waves to examine the organs within the abdomen. Ultrasound examination of the abdomen may disclose gallstones, tumours in the liver or the pancreas, and dilated bile ducts due to obstruction ( by gallstones or tumour).It is useful in distinguishing an obstructing lesion from hepatocellular disease in the evaluation of a jaundiced patient. While ultrasonography is the most sensitive imaging technique for detecting biliary stones, CT scanning can provide more information about liver and pancreatic diseases. 

Endoscopic retrograde cholangiopancreatography ( ERCP) and endoscopic ultrasound : ERCP provides the best means for examining the bile duct. It is particularly good at demonstrating the cause and location of obstruction within bile ducts. A major advantage of ERCP is that diagnostic and therapeutic procedures can be done at the same time as the X-rays. For example, if gallstones are found in the bile ducts, they can be removed. Stents can be placed in the bile ducts to relieve the obstruction caused by scarring or tumours. Biopsies of tumours can be obtained. 

Ultrasonography can be combined with ERCP by using a specialized endoscope capable of doing ultrasound scanning. Endoscopic ultrasound is excellent for diagnosing small gallstones in the gall bladder and bile ducts that can be missed by other diagnostic methods such as ultrasound, CT, and MRI. 

Ct or CAT Scan : CT Scan is particularly good for identifying tumours in the liver and the pancreas and dilated bile ducts, though it is not as good as ultrasonography for identifying gallstones. 

MRI : It is good for identifying tumours and studying bile ducts. MRI scans can be modified to visualize the bile ducts better than CT scans ( a procedure referred to as MR cholangiography) and therefore , are better than CT for identifying the cause and location of bile duct obstruction. 

Liver biopsy : A liver biopsy provides information on the liver architecture and is used mostly for determining prognosis. It may also be useful for diagnosis if serum and imaging studies to not lead to a firm diagnosis. Liver biopsy can be particularly helpful in diagnosing autoimmune Hepatitis or biliary tract disorders. The biopsy is commonly done with a long needle after local injection of the skin in the abdomen overlying the liver with anaesthetic. The needle passes through the skin and into the liver, cutting off a small piece of liver tissue. When the needle is withdrawn, the piece of liver tissue comes with it and is then examined under the microscope. 

Treatment of Jaundice

The treatment of jaundice requires a diagnosis of the specific cause of the jaundice and then treatment is directed at the specific cause causing the disease. 

Jaundice
Causes and Symptoms of Jaundice
Urine Analysis and Blood Testing for Jaundice