April Week 3: Hepatitis


  1. Harb R, et al. Conjugated Hyperbilirubinemia: Screening and Treatment in Older Infants and Children. Peds in Review. 2007;28;83-91.
  2. Pratt DS, Kaplan MM. Evaluation of Abnormal Liver Enzyme Results in Asymptomatic Patients. NEJM 2000;342: 1266-1271.

Case 1:

A 6 year old healthy boy comes to the urgent care clinic because of chronic abdominal pain. The symptom has been present for 1 year with no impact on his general health. The parents have been told that the child has been diagnosed with functional abdominal pain. His physical examination is normal. Because of the parents concern, you obtain a CBC, UA, complete metabolic panel, amylase, lipase and liver chemistries. Several days later, you review the laboratory evaluation. Everything is normal except for an AST of 300 IU/L and an ALT of 150 IU/L. You call the parents and they report the child is fine.

1. What is your next step? 
2. You repeat the tests and the results are the same. What will you do next?

Case 2:

A 13 year old girl presents to the emergency room with the chief complaint of yellow eyes. She has been feeling unwell for about 7 days, complaining chiefly of fatigue, poor appetite, mild abdominal pain and diarrhea. Her family assumed that she had a viral gastroenteritis but are now concerned because the symptoms have persisted.

1. What questions do you ask that will help determine the whether she has conjugated or unconjugated hyperbilirubinemia?

When you obtain blood work, these are the results:
Bilirubin T/D 10.6/5.8 mg%
AST/ALT – 350/400
Alkaline phosphatase – 250 IU/L
CBC – Hg 11.5 g%, WBC 8,900 with 67% segs, 30% lymphocytes and
occasional atypical lymphocytes.

2. What are other common causes of acute onset conjugated hyperbilirubinemia besides infectious hepatitis? How do you rule these diagnoses out?

3. What blood tests would you order in this child?