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Blood tests in biliary disease

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

  • blood tests generally include:
    • full blood count, urea and electrolytes, liver function test (LFT), calcium, albumin and international normalised ratio (INR)
  • biliary disease typically produces a cholestatic picture – elevated alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT) with variable abnormalities of the transaminases (AST, ALT)
    • in the early stages of biliary obstruction - ALT rises before the ALP; cholestasis produces a conjugated hyperbilirubinaemia
      • INR and albumin indicate the synthetic function of the liver - these are good indicators of severity of disease in conjunction with bilirubin

If there are renal function abnormalities in the presence of liver disease then this generally indicates a worse prognosis.

Haematological investigations:

  • leucocytosis with a neutrophilia if biliary sepsis
  • anaemia of varying degrees may be present
    • iron deficiency - if there has been chronic gastrointestinal blood loss
    • macrocytosis - may occur secondary to alcohol abuse or small bowel diseases, eg bacterial overgrowth and parasitic infestations

Reference:

  1. Prescriber 2003; 14(23):20-9.

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