Differential Diagnosis for Hyperbilirubinemia with Normal Alk Phos and Admission for Cholelithiasis
- Single Most Likely Diagnosis
- Choledocholithiasis: This condition, where a gallstone is lodged in the common bile duct, can cause obstructive jaundice leading to hyperbilirubinemia. The presence of cholelithiasis (gallstones) and normal alkaline phosphatase (alk phos) levels, which might not be elevated in the early stages or in all cases of choledocholithiasis, supports this diagnosis.
- Other Likely Diagnoses
- Cholecystitis: Inflammation of the gallbladder, often due to gallstones, can lead to hyperbilirubinemia if there is associated obstruction of the bile ducts. Normal alk phos does not rule out this condition, especially if the obstruction is intermittent or not severe.
- Mirizzi Syndrome: A rare complication of gallstone disease where a stone becomes impacted in the cystic duct or the neck of the gallbladder, causing obstruction of the common bile duct. This can lead to hyperbilirubinemia without significantly elevating alk phos levels.
- Do Not Miss Diagnoses
- Pancreatic Cancer: Although less likely, pancreatic cancer can cause obstructive jaundice and hyperbilirubinemia by compressing or invading the common bile duct. It's crucial to consider this diagnosis, especially in older patients or those with significant weight loss, as it requires prompt intervention.
- Cholangiocarcinoma: A cancer of the bile duct, which can also cause obstructive jaundice. Given its severity and the need for early treatment, it's essential to include it in the differential diagnosis.
- Rare Diagnoses
- Primary Sclerosing Cholangitis (PSC): A chronic liver disease characterized by inflammation and scarring of the bile ducts inside and outside the liver. It can cause hyperbilirubinemia but is less common and typically associated with inflammatory bowel disease.
- Primary Biliary Cholangitis (PBC): An autoimmune disease of the liver characterized by a progressive destruction of the bile ducts within the liver. It can lead to hyperbilirubinemia but usually presents with elevated alk phos levels and is more common in women.