Direct Bilirubin

Aka: Direct Bilirubin, Conjugated Bilirubin, Conjugated Hyperbilirubinemia, Obstructive Jaundice

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II. Lab: Normal

  1. <0.2 mg/dl

III. Causes: Increased Conjugated Bilirubin in Adults

  1. Intrahepatic Causes
    1. Viral Hepatitis (Hepatitis A, Hepatitis B, Hepatitis C)
    2. Alcoholic Liver Disease (e.g. Alcoholic Hepatitis, Alcoholic Cirrhosis)
    3. Nonalcoholic Steatohepatitis (NASH)
    4. Wilson Disease
    5. Hemochromatosis
    6. Ischemic Hepatitis
    7. Hepatocellular Carcinoma
    8. Drug induced cholestasis
    9. Prolonged Total Parenteral Nutrition
    10. Sarcoidosis
    11. Pregnancy
    12. Primary Biliary Cirrhosis
    13. Primary Sclerosing Cholangitis
    14. Sepsis
  2. Extrahepatic Causes (esp. Biliary Tract Obstruction)
    1. Choledocolithiasis
    2. Biliary stricture
    3. Biliary atresia
    4. Cholelithiasis
    5. Cholangitis
    6. Chronic Pancreatitis
    7. Cryptosporidium infection (Immunocompromised patient)
    8. HIV Infection
    9. Cytomegalovirus infection
    10. Cholangiocarcinoma
    11. Pancreatic Cancer
    12. Lymphoma
    13. Post-operative changes (Whipple Procedure, Billroth Procedure)

IV. Causes: Increased Conjugated Bilirubin in Neonatal Patients

  1. Sepsis
  2. Intrauterine Viral Infections
  3. Neonatal hepatitis
  4. Intrahepatic and extrahepatic biliary atresia
  5. Biliary tract obstruction
    1. Choledochal cyst
    2. Abdominal mass
    3. Annular Pancreas
  6. Trisomy 18
  7. Galactosemia
  8. Tyrosinemia
  9. Hereditary
    1. Dubin-Johnson Syndrome
    2. Rotor's syndrome
  10. Hypermethioninemia
  11. Alpha-1 Antitrypsin Deficiency
  12. Cystic Fibrosis
  13. Following Hemolytic Disease of the Newborn syndrome
    1. Inspissated bile
  14. Hypopituitarism
  15. Hypothyroidism

V. References

  1. Fargo (2017) Am Fam Physician 95(3): 164-8 [PubMed]
  2. Pasha (1996) Med Clin North Am 995-1019 [PubMed]

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