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Bilirubin

Serum total bilirubin is increased in hepatocellular damage (infectious hepatitis, alcoholic and other toxic hepatopathy, neoplasms), intra- and extrahepatic biliary tract obstruction, intravascular and extravascular hemolysis, physiologic neonatal jaundice, Crigler-Najjar syndrome, Gilbert's disease, Dubin-Johnson syndrome, and fructose intolerance.

Drugs known to cause cholestasis include the following:

aminosalicylic acid  androgens       azathioprine        benzodiazepines
carbamazepine        carbarsone      chlorpropamide      propoxyphene
estrogens            penicillin      gold Na thiomalate  imipramine
meprobamate          methimazole     nicotinic acid      progestins
penicillin           phenothiazines  oral contraceptives          
sulfonamides         sulfones        erythromycin estolate

Drugs known to cause hepatocellular damage include the following:

acetaminophen     allopurinol     aminosalicylic acid  amitriptyline
androgens         asparaginase    aspirin              azathioprine
carbamazepine     chlorambucil    chloramphenicol      chlorpropamide
dantrolene        disulfiram      estrogens            ethanol
ethionamide       halothane       ibuprofen            indomethacin
iron salts        isoniazid       MAO inhibitors       mercaptopurine
methotrexate      methoxyflurane  methyldopa           mithramycin
nicotinic acid    nitrofurantoin  oral contraceptives  papaverine
paramethadione    penicillin      phenobarbital        phenazopyridine
phenylbutazone    phenytoin       probenecid           procainamide
propylthiouracil  pyrazinamide    quinidine            sulfonamides
tetracyclines     trimethadione   valproic acid

Disproportionate elevation of direct (conjugated) bilirubin is seen in cholestasis and late in the course of chronic liver disease. Indirect (unconjugated) bilirubin tends to predominate in hemolysis and Gilbert's disease.

Decreased serum total bilirubin is probably not of clinical significance but has been observed in iron deficiency anemia.

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