Wallach's Interpretation of Diagnostic Tests: Pathways to Arriving at a Clinical Diagnosis (195 page)

   In contrast to primary biliary cirrhosis, antimitochondrial antibody, smooth muscle antibody, rheumatoid factor, and ANA are negative in >90% of patients.

   HBsAg is negative.

   Liver biopsy provides only confirmatory evidence in patients with compatible history, laboratory, and x-ray findings. Liver copper is usually increased, but serum ceruloplasmin is also increased.

Other Considerations

   Laboratory findings due to sequelae.

   Cholangiocarcinoma in 10–15% of patients may cause increased serum CA 19-9.

   Portal hypertension, biliary cirrhosis, secondary bacterial cholangitis, steatorrhea and malabsorption, cholelithiasis, and liver failure.

   Laboratory findings due to underlying disease (e.g., ≤7.5% of UC patients have this disease; much less often with Crohn disease). Associated with syndrome of retroperitoneal and mediastinal fibrosis.

CHOLECYSTITIS, ACUTE

   Laboratory Findings

   
Hematology
: Increased ESR, WBC (average 12,000/μL; if >15,000, suspect empyema or perforation), and other evidence of acute inflammatory process.

   
Core laboratory
: Serum AST is increased in 75% of patients. Increased serum bilirubin in 20% of patients (usually >4 mg/dL; if higher, suspect associated choledocholithiasis). Increased serum ALP (some patients) even if serum bilirubin is normal. Increased serum amylase and lipase in some patients

Considerations

   Laboratory findings of associated biliary obstruction if such obstruction is present

   Laboratory findings of preexisting cholelithiasis (some patients)

   Laboratory findings of complications (e.g., empyema of the gallbladder, perforation, cholangitis, liver abscess, pyelophlebitis, pancreatitis, gallstone ileus)