From the Guidelines
Posthepatic causes of hyperbilirubinemia are primarily due to obstruction of the biliary tract, which can be caused by intrinsic or extrinsic factors, such as cholelithiasis, cholangiocarcinoma, or pancreatitis, as stated in the most recent study 1.
Causes of Posthepatic Hyperbilirubinemia
The causes of posthepatic hyperbilirubinemia can be divided into intrinsic and extrinsic factors. Intrinsic factors include:
- Cholelithiasis
- Cholangiocarcinoma
- Choledocholithiasis
- Cholangitis Extrinsic factors include:
- Pancreatitis
- Pancreatic tumor
- Lymphoma
- Diffuse malignancy
Diagnosis and Treatment
Diagnosis of posthepatic hyperbilirubinemia typically requires imaging studies such as ultrasound, CT, MRI/MRCP, or ERCP, along with liver function tests showing elevated alkaline phosphatase and gamma-glutamyl transferase 1. Treatment depends on the underlying cause but often involves endoscopic or surgical intervention to relieve the obstruction. Prompt diagnosis and management are essential as prolonged biliary obstruction can lead to secondary biliary cirrhosis, cholangitis, and other complications.
Key Points
- Posthepatic hyperbilirubinemia is caused by obstruction of the biliary tract
- Intrinsic and extrinsic factors can cause obstruction
- Diagnosis requires imaging studies and liver function tests
- Treatment involves endoscopic or surgical intervention to relieve the obstruction
- Prompt diagnosis and management are essential to prevent complications, as supported by the most recent study 1.
From the Research
Posthepatic Causes of Hyperbilirubinemia
- Posthepatic disorders can cause conjugated hyperbilirubinemia, as stated in the study 2
- The most common posthepatic process that causes jaundice is gallstone formation, however, other serious conditions such as biliary tract infection, pancreatitis, and malignancies can also be posthepatic causes of hyperbilirubinemia 2
- Obstructive jaundice can be caused by growth/masses and stones in the bile ducts, which can be diagnosed and treated with endoscopic retrograde cholangiopancreatography (ERCP) 3
- Cholangiocarcinoma, a malignancy of the bile ducts, is a posthepatic cause of hyperbilirubinemia and can be treated with ERCP-directed therapies such as stenting, photodynamic therapy (PDT), and radiofrequency ablation (RFA) 4
Diagnosis and Evaluation
- The diagnosis of posthepatic causes of hyperbilirubinemia typically involves a urine test for bilirubin, followed by abdominal imaging by ultrasonography or computed tomographic scanning 2
- ERCP can be used to evaluate patients with obstructive jaundice and to diagnose and treat posthepatic causes of hyperbilirubinemia 3, 4
- The evaluation of patients with jaundice should start with a careful history and physical examination, followed by directed imaging of the biliary tree and liver 5