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Over the past few decades, there has been an increase in the number of reports about newly recognized (atypical or unusual) manifestations of Graves' disease (GD), that are related to various body systems. One of these manifestations is sometimes the main presenting feature of GD. Some of the atypical manifestations are specifically related to GD, while others are also similarly seen in patients with other forms of hyperthyroidism. Lack of knowledge of the association between these findings and GD may lead to delay in diagnosis, misdiagnosis, or unnecessary investigations. The atypical clinical presentations of GD include anemia, vomiting, jaundice, and right heart failure. There is one type of anemia that is not explained by any of the known etiological factors and responds well to hyperthyroidism treatment. This type of anemia resembles anemia of chronic disease and may be termed GD anemia. Other forms of anemia that are associated with GD include pernicious anemia, iron deficiency anemia of celiac disease, and autoimmune hemolytic anemia. Vomiting has been reported as a presenting feature of Graves' disease. Some cases had the typical findings of hyperthyroidism initially masked, and the vomiting did not improve until hyperthyroidism has been detected and treated. Hyperthyroidism may present with jaundice, and on the other hand, deep jaundicemay develop with the onset of overt hyperthyroidism in previously compensated chronic liver disease patients. Pulmonary hypertension is reported to be associated with GD and to respond to its treatment. GD-related pulmonary hypertension may be so severe to produce isolated right-sided heart failure that is occasionally found as the presenting manifestation of GD. [ABSTRACT FROM AUTHOR]

Objective:The use of transcutaneous bilirubin (TcB) measurements has been studied extensively in the newborn population, but there have been few studies in outpatient populations and none from the offices of practicing pediatricians.Study Design:We performed TcB measurements on a mixed-race population of 120 jaundiced infants, 35 weeks of gestation, in two hospital-based outpatient clinics, a regional public health nurse follow-up program and two pediatric office practices. Three individual TcB readings were obtained from the mid-sternum, and the average and maximum values were recorded.Result:There was good correlation between the TcB and total serum bilirubin (TSB) measurements (r=0.78, P=0.0). 59% of TSB's were 15 mg dl−1 and, although the number of false-negative readings increased when the TSB values exceeded 15 mg dl−1, it was nevertheless possible to use TcB measurements to accurately predict the risk of TSB levels 15 mg dl−1.Conclusion:In outpatient settings, a TcB measurement with the JM-103 provides a reliable screening method for the identification of hyperbilirubinemia even when the TSB level exceeds 15 mg dl−1. Using the maximum of three independent measurements reduces the number of false negatives, but increases the number of false positives. The use of TcB measurements in an outpatient practice should be a valuable tool for the practitioner. [ABSTRACT FROM AUTHOR]

Background: ERCP is very useful Method in diagnose and treatment of jaundice and obscure abdominal pain. In this study patients who had hospitalised due to jaundice and obscure abdominal pain and very different examination had been performed for them, were studied for terminal diagnose using ERCP. Methods: Patients' records of 100 patients who ERCP had been done for them during 1382-1389 were investigated. All available information including history, lab data and physical exams as well as paraclinical findings at the time of ERCP were collected. Finding: Our findings indicates that 47% were diagnosed as stone, 27% as normal, 9% as cholangiocarcinoma, 4% as adenocarcinoma of papilla, 6% cancer of head of pancreas and 7% as other. Among those who primary diagnosis was cholestatic jaundice, 51% stone, 15.8% cholangiocarcinoma, 12.2% normal, 5.2% adenocarcinoma of papilla, b.7% cancer of head of pancreas and 7% others were diagnosed using ERCP. This figures for patient with primary diagnosis of right upper quadrane pain was 66.7% normal, 25% stone and 8.3% pancreatic cancer. Conclusion: It seems that stone is the most common cause of jaundice and obscure abdominal pain. The most prevalent final diagnosis for those with primary diagnosis of cholestatic jaundice was stone and cholangiocarcinoma afterwards. [ABSTRACT FROM AUTHOR]

Autoimmune or immunoglobulin G subtype (IgG4) pancreatitis is a newly recognised clinical entity and is an important differential diagnosis for patients presenting with obstructive jaundice. Knowledge of autoimmune pancreatitis (AIP) continues to evolve both for pathogenesis and management; however diagnosis is often not straightforward or even considered, therefore a high index of suspicion remains an important tool for the treating physician. The six cases presented illustrate both the difficulties in diagnosis as well as management of this condition. [ABSTRACT FROM AUTHOR]

Objective: Hepatitis A virus infections are a widespread disease with important morbidity and mortality in adults. The aim of this study is to evaluate the clinical and laboratory findings, treatment and prognosis of the acute viral hepatitis A cases in our hospital. Material and Method: IIn this study, 241 children diagnosed with acute viral hepatitis A were evaluated according to demographic and clinical characteristics between April 2007 and August 2008. Results: Of the patients, 134 (55.6%) were male and 107 (44.4%) were female, and the mean age of the patients was 7±5 years (range, 2-16). The incidence of hepatitis A was higher in autumn and winter. In 169 (70.1%) of the cases no route of transmission could be determined. The most common symptoms were jaundice (82.1%), weakness (80%), nausea (74.2%), anorexia (70.9%) and dark urine (68%). The most common signs were jaundice (94.2%), hepatomegaly(58.1%) and splenomegaly (21.6%). The total rate of hematological abnormalities was 43.1% and fulminant hepatitis was seen in 1.2% of the patients. The mortality rate was determined as 0.8%. Conclusions: Hepatitis A remains an important public health problem in the country. The disease causes more severe clinical symptoms and requires rest during the epidemic in adults. Therefore, hepatitis A vaccination may be useful in early childhood in hyperendemic regions. [ABSTRACT FROM AUTHOR]

The term cholestasis is Greek in origin, meaning bile stoppage. In its most overt form, cholestasis presents to the clinician as jaundice. However, jaundice is only the tip of the iceberg of cholestatic liver disease. The incidence of neonatal cholestasis is estimated around 1 in 2500 live births. Cholestasis must always be considered in newborns with prolonged jaundice lasting more than 14-21 days. There are a number of contributing factors for neonatal cholestasis which include bile duct abnormalities; infections, such as sepsis and urinary tract infections; inherited and metabolic disorders; endocrine disorders; chromosomal disorders; toxicity from parenteral nutrition; vascular disorders; prematurity, lack of enteral feedings and medications. The most common causes of neonatal cholestasis are biliary atresia and idiopathic neonatal hepatitis. [ABSTRACT FROM AUTHOR]

Abstract  A 25-year-old immunocompetent Japanese man was referred to us for investigation and treatment of obstructive jaundice. Computed tomography (CT) showed dilatation of the bilateral intrahepatic bile ducts and a low-attenuated mass extending along the portal tract, from the hepatic hilum to the periphery, suggestive of cholangiocellular carcinoma (CCC) with periductal infiltration. However, the culture of bile obtained by percutaneous transhepatic biliary drainage revealed Cryptococcus neoformans. Microscopic examination of a biopsy specimen of the mass-like lesion in the liver revealed fungal organisms encapsulated in multinucleated giant cells. A small area of infiltration in the left lung was also detected on chest CT, and a diagnosis of liver and lung cryptococcosis was made. After 8 months of antifungal therapy, both the liver and lung lesions had vanished and the biliary stricture resolved. Unnecessary surgical intervention was avoided by an early and accurate diagnosis and effective antifungal therapy. The bile culture was the key to the definitive diagnosis in this case. [ABSTRACT FROM AUTHOR]

The purpose of this study is to classify biliary atresia (BA) with a “cyst at porta” according to the cholangiographic anatomy and to define management strategy and outcome in each group. A cyst at porta was identified in 13 of 58 babies (22.4%) with BA at first presentation. The cholangiographic anatomy was classified as; Group A ( n = 7), type III BA with extrahepatic cyst; Group B ( n = 2), type I or II BA with extrahepatic biliary cyst; and Group C ( n = 4), type I or II BA with both extrahepatic and intrahepatic biliary cysts. The remaining 45 patients were comprised of type III BA without a cyst. A Kasai’s portoenterostomy (PE) was performed for all Group A patients. Groups B and C were treated by hepaticojejunostomy ( n = 5) or portoenterostomy ( n = 1). All 45 patients with type III BA without a cyst were treated by a Kasai’s PE. The median age at surgery was 92 days (ranges 28–342 days). There were three early post-operative deaths, all in patients with type III BA without cyst. Overall 18/55 (32.7%) patients achieved a jaundice free state. In Group A, 5/7 (71.4%) patients had bile flow, 2/7 (28.6%) are anicteric and 2/7(28.6%) had 1–2 episodes of post-operative cholangitis. In Group B, both patients are anicteric and none had post-operative cholangitis. In Group C, all four babies had bile flow but, significant morbidity because of recurrent severe cholangitis. Only one patient reached a jaundice free state. Of the remaining 42 patients with type III BA without a cyst, 27 (64.3%) had bile flow, 13 (31%) became jaundice free and 14 (33.3%) have had 1–2 episodes of post-operative cholangitis. In conclusion, thirteen of 58 (22.4%) babies with BA had a “cyst at porta” at first presentation in this series. The outcome was most satisfactory in type I BA without intrahepatic cystic dilatation (Group B) in terms of achieving a jaundice free state and freedom from recurrent cholangitis. However, intrahepatic biliary cysts (Group C) were associated with recurrent severe cholangitis and a poor eventual outcome despite a good initial bile flow. The outcome in type III BA with extrahepatic cyst was comparable to type III BA without cyst. [ABSTRACT FROM AUTHOR]

Primary biliary cholangitis is a rare liver disease which often progresses to cirrhosis. It can be difficult to diagnose as patients are often asymptomatic initially or merely complain of fatigue or pruritus. We describe the case of a 56‐year‐old female who presented with a 2‐month history of painless jaundice and constitutional symptoms. Computed tomography scan showed massive hepatosplenomegaly with abdominal lymphadenopathy. Liver biopsy and a strongly positive antimitochondrial antibody titer confirmed the diagnosis of primary biliary cholangitis. [ABSTRACT FROM AUTHOR]

Objective: In critical illness, liver dysfunction (LD) is associated with a poor outcome independently of other organ dysfunctions. Since strategies to support liver function are not available, a timely and accurate identification of factors promoting LD may lead to prevention or attenuation of its consequences. The aim of this study was to assess risk factors for LD in critically ill patients.Design: Prospective, observational study.Setting: A multidisciplinary intensive care unit (ICU) of a university hospital.Patients: All patients consecutively admitted over a 6-month period.Intervention: None.Measurements and Results: LD was defined as serum bilirubin levels >or=2 mg/dl and lasting for at least 48 h. Out of 283 patients, 141 matched inclusion criteria. Forty-four patients (31.2%) showed LD (LD group), while 97 (68.8%) were included in control group (C group). A binomial analysis showed that LD occurrence was associated with moderate (odds ratio [OR] 3.11; p=0.04) and severe shock (OR 3.46; p= 0.05), sepsis (OR 3.03; p=0.04), PEEP ventilation (OR 4.25; p=0.006), major surgery (OR 4.03; p=0.03), and gram-negative infections (OR 3.94; p=0.002). In stepwise multivariate analysis, the single independent predictive factors of LD resulted in severe shock (p=0.002), sepsis (p=0.03), PEEP ventilation (p=0.04), and major surgery (p=0.05).Conclusions: In critically ill patients jaundice is common, and severe shock states, sepsis, mechanical ventilation with PEEP and major surgery are critical risk factors for its onset. Since there is no specific treatment, prompt resuscitation, treatment of sepsis and meticulous supportive care will likely reduce its incidence and severity. [ABSTRACT FROM AUTHOR]

Background: Computer-assisted diagnostic systems are not substantially more accurate than the clinician in the differential diagnosis of jaundice but may help in optimal selection and sequencing of tests. The present study aimed to assess with an electronic diagnostic tool the pattern of ordering tests and the diagnostic contribution and related financial cost of each test in jaundiced patients with pancreatobiliary carcinoma, in an effort to make the clinician's diagnostic behaviour more efficient and economical. Methods: Clinical and diagnostic test data were prospectively gathered from 356 jaundiced patients with pancreatobiliary carcinoma and entered in a Bayesian diagnostic programme. The test results were added to the existing diagnostic evidence, and the programme calculated the diagnostic contribution of each test. Results: A total of 1804 diagnostic tests were ordered. Quantitative assessment of the diagnostic contribution of each test showed that percutaneous transhepatic cholangiography and computed tomography were associated with the highest provision of information. The most cost-effective tests were ultrasonography and liver function tests. Conclusions: It is possible to determine objectively the diagnostic contribution of each test in establishing the diagnosis of pancreatobiliary carcinoma. The observed physician behaviour in ordering the various diagnostic tests might be improved with regard to its efficacy and its cost-effectiveness profile. [ABSTRACT FROM AUTHOR]

Objectives: While jaundice is frequently described in the sclera and skin, there are few reports of true vocal fold jaundice in patients with high bilirubin, and no reports by otolaryngologists in the literature. Here we describe a case of a patient with bilateral true vocal fold jaundice and discuss the potential pathogenesis and implications of this finding., Methods: A 29-year-old man with history of Dubin-Johnson Syndrome presented with cough and difficulty breathing and was incidentally found to have persistent yellow discoloration of the true vocal folds bilaterally., Results: Videolaryngoscopic exam demonstrated bilateral true vocal fold yellow discoloration with sparing of nearby laryngeal structures on initial presentation and follow-up exam. Direct and total bilirubin levels were found to be elevated., Conclusion: A patient with benign Dubin-Johnson Syndrome and elevated total and direct bilirubin was incidentally found to have bilateral vocal fold jaundice. Jaundice and the presence of bilirubin do not appear to cause harm to the function or health of the true vocal folds and may be related to the high concentration of elastin present in the true vocal folds., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Jaundice is a clinical symptom as a result of cholestasis. It can be caused by a wide variety of disorders. Its differential diagnosis is broad. Therefore, it is important to determine whether the cause of the cholestasis is intrahepatic, hepatic or extrahepatic. Case description This article describes a 61-year-old male who was referred to our Gastroenterology Department. Transabdominal ultrasound showed dilatation of intrahepatic bile ducts and the common bile duct, probably caused by a sludge ball. He underwent an ERCP during which a mass instead of a gallstone was extracted. Histological examination showed (a metastasis of) a melanoma. The patient was referred to the dermatologist who found a melanoma on the chest. The final diagnosis was metastasis of melanoma to the common bile duct., Conclusion: Jaundice can be caused by a variety of disorders. A systematic approach based on signs and symptoms is essential to recognize uncommon diagnoses without unnecessary delay.

Background and Objective: Previously reported prevalence of urinary tract infections (UTIs) in infants with jaundice range from <1% to 25%. However, UTI criteria are variable and, as demonstrated in a meta-analysis on UTI prevalence in bronchiolitis, disease prevalence is greatly impacted by disease definition. The objective of this study was to conduct a systemic review and meta-analysis examining the impact of including positive urinalysis (UA) results as a diagnostic criterion on the estimated UTI prevalence in young infants with jaundice., Methods: The data sources used were Medline (1946-2020) and Ovid Embase (1976-2020) through January 2020 and bibliographies of retrieved articles. We selected studies reporting UTI prevalence in young infants with jaundice. Data were extracted in accordance with meta-analysis of observational studies in epidemiology guidelines. Random-effects models produced a weighted pooled event rate with 95% confidence intervals (CI)., Results: We screened 526 unique articles by abstract and reviewed 53 full-text articles. We included 32 studies and 16 contained UA data. The overall UTI prevalence in young infants with jaundice from all 32 studies was 6.2% (95% CI, 3.9-8.9). From the 16 studies with UA data, the overall UTI prevalence was 8.7% (95% CI, 5.1-13.2), which decreased to 3.6% (95% CI, 2.0-5.8) with positive UA results included as a diagnostic criterion., Conclusions: The estimated UTI prevalence in young infants with jaundice decreases substantially when UA results are incorporated into the UTI definition. Due to the heterogeneity of study subjects' ages and definitions of jaundice, positive UA results, and UTI, there is uncertainty about the exact prevalence and about which infants with hyperbilirubinemia warrant urine testing., (Copyright © 2022 by the American Academy of Pediatrics.)

Thyroxine and triiodothyronine regulate the basal metabolic rate of all cells, including hepatocytes, and thereby, modulate hepatic function. Thus, thyroid dysfunction may perturb liver function. Though a wide spectrum of hepatic abnormalities has been attributed to hyperthyroidism with or without complications, such abnormalities are rare to be found and require high index of suspicion. In this case report, we present a female patient who was admitted with the complaints of generalised weakness, jaundice and shortness of breath. She initially had clinical presentation similar to that of congestive cirrhosis, but eventually proved to be a case of hyperthyroidism leading to hepatic dysfunction. Turk Jem 2015; 19: 76-78 [ABSTRACT FROM AUTHOR]

Background: Jaundice is a common clinical finding in clinical practice of hepatologists and general practitioners. It occurs when serum bilirubin levels exceed 3 mg/dL., Summary: In this review, we summarize the pathophysiological mechanism of jaundice, clinical approach to the patient with jaundice, and laboratory and imaging techniques. Clinical presentation of jaundice manifests through yellow skin and sclera coloration. Evaluation of every patient includes detailed medical history and examination. In the laboratory, evaluation of enzymes of hepatic inflammation as well as cholestatic enzymes with serum bilirubin must be included. Additional laboratory analysis and imaging modalities are needed in order to differentiate jaundice etiology. Moreover, imaging is available and needed in further evaluation, and treatment is dependent on the underlying cause., Key Messages: In this review, we will outline the pathophysiological mechanism of jaundice, clinical approach to the patient with jaundice, and diagnostic and treatment approach to these patients., (© 2021 S. Karger AG, Basel.)

Many diagnostic studies and procedures are available for the evaluation of jaundice. By judicious selection of those that are most likely to lead to a prompt diagnosis and by weighing their relative risk and efficacy, the physician can better ensure the comfort and safety of the patient and the cost-effectiveness of medical care. A guideline is presented that recommends an approach to the evaluation of jaundice. It is based on a critical review of the literature and its application to clinical practice. [ABSTRACT FROM AUTHOR]

This paper presents a decision model for a serious medical problem: the diagnosis and treatment of undifferentiated liver disease with jaundice. The model formalizes the use of information before a treatment is chosen, taking account of prior information collected by the doctor from laboratory and clinical exploration. Then the model chooses the best treatment according to the patient's preference structure. Since the best treatment in each case depends on the patient's preference for consequences, this aspect is central to the application of such models. Thus a main objective is to find a suitable criterion to measure the consequences in order that each patient's attitude can be taken into account. Our model was computerized and tested with fifty patients: the program duplicated in forty-four cases the decisions of expert doctors. The model overcomes some of the difficulties observed in the manipulation of probabilities by clinicians. The results suggest that a Decision Analysis model may be a useful way to clarify the decision process of expert clinicians and to help in the education of new doctors. Finally, this kind of program can play a role in automating medical decision-making in such a way that the knowledge of the best experts can be made widely available. [ABSTRACT FROM AUTHOR]

Discusses the combined use of percutaneous transhepatic cholangiography and endoscopic ampullary cholangiography in the diagnosis of difficult jaundice cases. Case of a 73-year-old woman with painless jaundice; Case of a 73-year-old man with pruritus, jaundice and weight loss; Case of an 81-year-old female with jaundice, chills and fever.

The article examines the multiphasis screening program for somatic disease among elderly long-term psychiatric patients. It describes somatic health problems in a mental hospital, as revealed by a multiphasis screening program applied to a selected group of long-term psychiatric patients. They have also discussed the value of regular somatic screening programs in mental hospitals. The magnitude of somatic health problems among psychiatric patients in hospital makes it mandatory that efforts are made to detect and treat disorders.

Discusses a study that focused on the fecal excretion of Rose Bengal I³ in the diagnosis of obstructive jaundice in infancy with special reference to biliary atresia. Material and methods used; Determination of the fecal and reference standard radioactivity; Results of the study.

Describes the use of latex fixation tests in non-rheumatic states. Differential diagnosis of jaundice; Clinical manifestations of hypermacroglobulinemia; Cost-effectiveness of latex fixation tests.

Percutaneous transhepatic cinécholangiography, utilizing cinéfluorography as an adjunct to percutaneous cholangiography, provides a continuous and dynamic visualization of the filling of the biliary ductal system, graphically demonstrating organic, pathologic, and physiologic mechanisms. The diagnostic accuracy in both the jaundiced patient and in the patient with liver disease of obscure etiology is thereby greatly increased. The technic is described and its value discussed. [ABSTRACT FROM AUTHOR]

Discusses a study on the use of radioactive rose bengal as a test in the differential diagnosis of jaundice. Procedures involved in the process of removing rose bengal; Method used in the study on the use of rose bengal in the diagnosis of patients with jaundice; Results of the study.

Presents a case study on jaundice in a 52-year old female with a history of gastrointestinal complaints. Interpretation of the liver biopsies of the patient; Information on cholangiolitic hepatitis; Histologic criteria used to separate the case of cholangiolitic hepatitis from extrahepatic biliary obstruction.

The article discusses the medical term which is called as the Courvoisier's sign in patients with painless jaundice and an enlarged palpable gallbladder who often have a non-calculus obstruction of the biliary system. It mentions that the sign was used as an important clinical indication for the differential diagnosis of jaundice for several decades.

"Biliary atresia (BA) is a common cause of jaundice in infancy. There is increasing evidence that newborn screening with direct or conjugated bilirubin leads to earlier diagnosis. Although the Kasai portoenterostomy is the primary treatment, there are scientific advances in adjuvant therapies. As pediatric patients transition to adult care, multidisciplinary care is essential, given the complexity of this patient population.", (Copyright © 2021 Elsevier Inc. All rights reserved.)

The COVID-19 pandemic is still raging across the world and vaccination is expected to lead us out of this pandemic. Although the efficacy of the vaccines is beyond doubt, safety still remains a concern. We report a case of a 65-year-old woman who experienced acute severe autoimmune hepatitis two weeks after receiving the first dose of Moderna-COVID-19 vaccine. Serum immunoglobulin G was elevated and antinuclear antibody was positive (1:100, speckled pattern). Liver histology showed a marked expansion of the portal tracts, severe interface hepatitis and multiple confluent foci of lobular necrosis. She started treatment with prednisolone, with a favorable clinical and analytical evolution. Some recent reports have been suggested that COVID-19 vaccination can lead to the development of autoimmune diseases. It is speculated that the vaccine can disturb self-tolerance and trigger autoimmune responses through cross-reactivity with host cells. Therefore, healthcare providers must remain vigilant during mass COVID-19 vaccination., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Rationale: Drug-induced liver injury (DILI) is the most common cause of acute liver failure in the United States. Painkillers and fever antipyretics are the most common cause of DILI. Hepatic injury can be provoked by DILI as hepatocellular or cholestatic type., Patient Concerns: A 48-year-old woman presented jaundice accompanied by nausea and vomiting. The patient was an inactive hepatitis B carrier with low viral titer and was diagnosed renal cell carcinoma (RCC) with hepatic metastasis requiring pazopanib treatment. Prior to administration of pazopanib, tenofovir administration was started to prevent exacerbation of hepatitis B. The patient was referred to clinic of gastroenterology department due to sudden elevation of bilirubin after 5 weeks of pazopanib treatment., Diagnoses: Abdominal ultrasound and computed tomography showed non-specific finding other than metastatic nodule in the liver and liver cirrhosis. After then, the patient was performed liver biopsy, and the biopsy result was acute cholestatic hepatitis with centrilobular area necrosis and portal inflammation. Therefore, considering the clinical history and biopsy results, the patient was diagnosed as DILI due to pazopanib., Interventions: After the biopsy, empirical steroid therapy was initiated and after 7 weeks of pazopanib discontinuation., Outcomes: The total bilirubin level returned to normal from peak level of 24.61 to 1.52 mg/dL., Lessons: In patients with renal cell carcinoma, pazopanib treatment requires clinical caution as it causes rare complications such as severe jaundice and acute cholestatic hepatitis., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Introduction: Hemolysis, icterus, and lipemia (HIL) are common pre-analytical variables in the clinical laboratory. Understanding their effects on coagulation laboratory results is essential., Methods: HIL effects on the prothrombin time (PT), activated partial thromboplastin time (APTT), dilute Russell's viper venom time (DRVVT), thrombin time (TT), and protein C chromogenic activity (CFx) were evaluated on the ACL TOP 750 optical analyzer and STA-R Evolution mechanical analyzer (PT and APTT only) by spiking normal donor, patient, and commercial control samples with varying concentrations of hemolysate, bilirubin, or a lipid emulsion. The relative difference or bias compared to the original results was determined., Results: Hemolysis (H) indices up to 900 mg/dL did not affect the APTT, PT, DRVVT Confirm, TT, and CFx; however, H indices above approximately 200 mg/dL resulted in a false-negative DRVVT screen and screen/confirm ratio in samples with a lupus anticoagulant. There was an artifactual prolongation of the PT and APTT when conjugated bilirubin was dissolved in aqueous solvents and not when it was dissolved in dimethyl sulfoxide. Icterus (I) indices up to 45 mg/dL did not result in significant (>15%) bias for all assays evaluated. The PT and APTT assays failed to produce a robust clot curve when the lipemia (L) index exceeded 6000 milliabsorbance units (mAbs), and the TT and DRVVT assays failed when the L index exceeded 3000 mAbs; the CFx assay was unaffected by lipemia., Conclusions: Verification of the manufacturer's recommended interference thresholds is important since it may avoid inappropriate instrument flagging and/ or sample rejection., (© 2021 John Wiley & Sons Ltd.)

Splenic artery (SA) originating from the superior mesenteric artery is a rare condition, and aneurysms in relation to this aberrant SA are even rarer. We reported the case of a 67-year-old female who presented with painless progressive jaundice for 2 months accompanied by thrombocytopenia and liver dysfunction. The computed tomographic angiography (CTA) showed an aberrant SAA located behind the pancreatic head along with the dilation of common bile duct. Stent-graft deployment in SMA and coil embolization of the aneurysm were performed. Her liver dysfunction and thrombocytopenia improved postoperatively. CTA at 2-year follow-up showed patency of stent-graft and SMA and the shrinkage of the excluded aneurysm sac. Considering the particular location of the aneurysm, painless progressive jaundice can be the initial symptom for the aberrant SAAs. This combined endovascular technique completely excluded the aneurysm and was beneficial for treating secondary liver dysfunction and thrombocytopenia.

Background: Fever with jaundice is a common symptom of some infectious diseases. In public health surveillance within the Democratic Republic of the Congo (DRC), yellow fever is the only recognized cause of fever with jaundice. However, only 5% of the surveillance cases are positive for yellow fever and thus indicate the involvement of other pathogens. Leptospira spp. are the causative agents of leptospirosis, a widespread bacterial zoonosis, a known cause of fever with jaundice. This study aimed to determine the seropositivity of anti-Leptospira antibodies among suspected yellow fever cases and map the geographical distribution of possible leptospirosis in the DRC., Methods: We conducted a retrospective study using 1,300 samples from yellow fever surveillance in the DRC from January 2017 to December 2018. Serum samples were screened for the presence of IgM against Leptospira spp. by a whole cell-based IgM ELISA (Patoc-IgM ELISA) at the Institut National de Recherche Biomedicale in Kinshasa (INRB) according to World Health Organization (WHO) guidance. Exploratory univariable and multivariable logistic regression analyses were undertaken to assess associations between socio-demographic factors and the presence of Leptospira IgM., Results: Of the 1,300 serum samples screened, 88 (7%) showed evidence of IgM against Leptospira spp. Most positive cases (34%) were young adult males in the 20-29-year group. There were statistically significant associations between having Leptospira IgM antibodies, age, sex, and living area. Observed positive cases were mostly located in urban settings, and the majority lived in the province of Kinshasa. There was a statistically significant association between seasonality and IgM Leptospira spp. positivity amongst those living in Kinshasa, where most of the positive cases occurred during the rainy season., Conclusions: This study showed that leptospirosis is likely an overlooked cause of unexplained cases of fever with jaundice in the DRC and highlights the need to consider leptospirosis in the differential diagnosis of fever with jaundice, particularly in young adult males. Further studies are needed to identify animal reservoirs, associated risk factors, and the burden of human leptospirosis in the DRC., Competing Interests: The authors have declared that no competing interests exist.

Introduction: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 virus, is a predominantly respiratory tract infection with the capacity to affect multiple organ systems. Abnormal liver tests, mainly transaminase elevations, have been reported in hospitalized patients. We describe a syndrome of cholangiopathy in patients recovering from severe COVID-19 characterized by marked elevation in serum alkaline phosphatase (ALP) accompanied by evidence of bile duct injury on imaging., Methods: We conducted a retrospective study of COVID-19 patients admitted to our institution from March 1, 2020, to August 15, 2020, on whom the hepatology service was consulted for abnormal liver tests. Bile duct injury was identified by abnormal liver tests with serum ALP > 3x upper limit of normal and abnormal findings on magnetic resonance cholangiopacreatography. Clinical, laboratory, radiological, and histological findings were recorded in a Research Electronic Data Capture database., Results: Twelve patients were identified, 11 men and 1 woman, with a mean age of 58 years. Mean time from COVID-19 diagnosis to diagnosis of cholangiopathy was 118 days. Peak median serum alanine aminotransferase was 661 U/L and peak median serum ALP was 1855 U/L. Marked elevations of erythrocyte sedimentation rate, C-reactive protein, and D-dimers were common. Magnetic resonance cholangiopacreatography findings included beading of intrahepatic ducts (11/12, 92%), bile duct wall thickening with enhancement (7/12, 58%), and peribiliary diffusion high signal (10/12, 83%). Liver biopsy in 4 patients showed acute and/or chronic large duct obstruction without clear bile duct loss. Progressive biliary tract damage has been demonstrated radiographically. Five patients were referred for consideration of liver transplantation after experiencing persistent jaundice, hepatic insufficiency, and/or recurrent bacterial cholangitis. One patient underwent successful living donor liver transplantation., Discussion: Cholangiopathy is a late complication of severe COVID-19 with the potential for progressive biliary injury and liver failure. Further studies are required to understand pathogenesis, natural history, and therapeutic interventions., (Copyright © 2021 by The American College of Gastroenterology.)

Early diagnosis and appropriate treatment of cholangiocarcinoma is problematic. Cross sectional imaging and tumor marker CA 19-9 are not absolutely reliable and tissue sampling is difficult. We present a patient with cholangitis and cystic dilation of intra-hepatic bile ducts that primarily diagnosed as Caroli's disease in imaging and needle biopsy but laparotomy and surgical biopsy revealed cholangiocarcinoma. [ABSTRACT FROM AUTHOR]

Jaundice corresponds to elevated bilirubin- levels, whereat one has to distinguish between direct and indirect serum-bilirubin. In the present Mini Review causes and differential diagnosis of jaundice are outlined. Ultrasound-diagnostic plays a major role in identifying intrahepatic or extra-hepatic jaundice. Attention is given to the differential diagnosis of elevated liver enzymes in presence of jaundice, pointing out the distinction between hepatocellular and cholestatic parameters as well as the differentiation in acute or chronic increase. Moreover, the consequences of liver enzyme elevations including further diagnostic procedures, are highlighted. Finally, possibilities and limitations of modern diagnostic tests for liver fibrosis are briefly overviewed. [ABSTRACT FROM AUTHOR]

Thyrotoxic crisis is a life threatening condition which requires urgent detection and management. Due to its wide variety of presentation its diagnosis can be difficult in some cases and high index of suspicion is required for its diagnosis. We report a case of 45 year old lady presenting with fever, jaundice and passage of loose stool whose thyroid hormone profile proved her to be suffering from thyrotoxic crisis. [ABSTRACT FROM AUTHOR]

Objective Jaundice is one of the presenting signs of urinary tract infection (UTI). Prevalence of UTI in febrile infants is between 5% and 11%. Previous studies have shown that jaundice may be one of the preen - ring signs of sepsis or urinary tract infection in newhorns. The goal of this study was to determine the prevalence of UTI in asymptomatic, jaundiced neonates. Methods Eighty five asymptomatic unexplained jaundice evaluated for evidence of UTI by suprapuhic bladder aspiration. UTI defined as one colony forming units per milliliter of single pathogen obtained on all study infants. Detailed questionnaires were completed include demographic information. Results Seven (8.2%) of 85 infants had UTI. Isolated pathogens included E. coli, Kelebsiella, Entrococcous, Co-agulase negative Staphylococcus and Entrobacter Aerogenese. There were no correlation between total and direct serum bilirubin level and positive urine culture (P 0.78 and P 0.44 respectively). Conclusion A UTI was found in 8.2% of asymptomatic unexplained afebrial jaundiced neonate. More studies is necessary to answer this question: should urine culture be considered in asymptomatic jaundiced neonate. [ABSTRACT FROM AUTHOR]

Liver involvement is nearly universal in healthy persons with Epstein-Barr Virus (EBV) infection-induced infectious mononucleosis. It is usually mild, undetected clinically and resolves spontaneously. Jaundice is distinctly uncommon and may reflect either more severe hepatitis or an associated hemolytic anemia. Cholestatic hepatitis due to EBV infection is infrequently reported and may pose a diagnostic quandary. We describe a patient who presented with jaundice and a markedly elevated serum alkaline phosphatase level due to serologically confirmed acute infection with EBV. Imaging studies excluded biliary obstruction. Symptoms and laboratory abnormalities resolved spontaneously. EBV infection should be included in the differential diagnosis of cholestatic hepatitis in adults. [ABSTRACT FROM AUTHOR]

Rationale: Transient infantile hypertriglyceridemia (HTGTI) is a rare autosomal recessive inherited disease caused by inactivating mutations in the glycerol-3-phosphate dehydrogenase 1 gene. To date, only a few patients have been reported worldwide. The symptoms of the affected individuals present a certain degree of transient hypertriglyceridemia, hepatomegaly, elevated liver enzymes, persistent fatty liver and hepatic fibrosis in early infancy. However, the clinical characteristics and pathogenesis of this disease are remain unclear., Patient Concerns: A one month and twenty-five days old girl was admitted to hospital because of persisted jaundice and hepatomegaly for fifty days., Diagnose: The girl was diagnosed with HTGTI coincident with a noval mutation in glycerol-3-phosphate dehydrogenase 1., Intervention: She was advised to take low-fat diet and supplement of medium-chain fatty acids., Outcomes: Her jaundice was gradually normal at the age of 4 months without any treatment, and hypertriglyceridemia were normal at the age of 13 months, but still had elevated transaminases and hepatic steatosis., Lessons: Jaundice may be a novel phenotype in HTGTI. The report contributes to the expansion of HTGTI's gene mutation spectrum and its clinical manifestations., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Hepatitis A virus (HAV) is the most common cause of acute viral hepatitis in the world. Infection with hepatitis A virus can cause severe or even fatal illness in patients with chronic liver disease. Here we present a case which seems to be an isolated acute viral hepatitis A infection at the beginning but later found to be coexisted with Wilson's disease. A 14-year-old girl presented in the Department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh on 11th April 2019 with progressive jaundice with prodrome, dark urine, itching, hepatomegaly and thyromegaly. She was found positive for serum IgM HAV antibody. Her jaundice was increasing along with prolonged prothrombin time and low albumin. She had coexisting Wilson's disease evidenced by increased 24 hours urinary copper (138μgm/day). She was treated with D-Penicillamine and Zinc acetate. Hepatitis A can be considered as a factor for acute decompensation in undiagnosed patients with Wilson's disease. So it is very crucial to investigate Wilson's disease in appropriate clinical setting of prolonged jaundice and liver dysfunction.

Tuberculosis (TB) is one of the most common infectious diseases worldwide. The case of a 20-year old male refugee from Somalia, who initially presented with right-sided upper abdominal pain, vomiting, weight loss and jaundice with suspected cholecystitis is reported. In the course of further diagnostics, pyloric stenosis surprisingly appeared, which, like the cholestasis, was caused by compressing peripancreatic lymph nodes. Lymph node cytology finally showed evidence of caseating necrosis with evidence of TB pathogens.