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Gilberts syndrome

Resolved Question:

Bilirubin was 2.8 six months ago, 2.5 two months ago, Restested last week now completely normal. Any Idea why it was high but now normal . My Dr though Gilberts syndrome

Bilirubin Direct was .8, .3, now.1
Bilirubin Indirect 1.7,.now .5
Negative hepetitis test
Ret count and LDH normal
No alcohol or drug use,(
all liver test normal,CBC normal,ultrasound normal.)


Category: Family Physician-GP

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Dr. Deepu Sebin Sebastian is online now

Expert:  Dr. Deepu Sebin Sebastian replied 4 Days.

Hello, and thankyou for approaching DoctorSpring with your query. Gilberts Syndrome is the most common cause of asymptomatic hyberbilirubinemia in adults as in your case. It is an inherited condition (autosomal recessive- which means your parents would be carriers for the gene of the disease but did not manifest the disease). Though it is inherited it usually manifests later in life.

Quiet often as in your case the individuals will have normal bilirubin levels or the levels fluctuate upto 3mg/dl. Certain factors (which I have listed below) will cause a rise in the bilirubin levels (a slightly higher increase in Indirect bilirubin) . The total bilirubin levels in such conditions will rise from normal to even upto 6mg/dl. Factors that cause bilirubin levels to rise would be
1) Break down of blood cells as seen in say an infection. This breakdown of blood cells causes and increase in bilirubin production.
2)Fasting is known to cause a 2-3 fold increase in bilirubin levels. The levels returns to normal within 12-24 hours of resuming a normal diet.
3)Fever, physical exertion, stress also increase bilirubin levels in this condition.
4)Certain medications such as I.V use of paracetamol, nicotinic acid cause an increase in the bilirubin levels.

This condition has no treatment, and its just about you being aware that you have this condition and have nothing to worry. The negative results of the rest of the tests performed on you further point to this diagnosis. To confirm your diagnosis you need to monitor the above tests over 12-18 months. If the above tests are normal (except the bilirubin levels) your diagnosis is definite. I advise you to repeat the above tests in 6 months and then in another 6 months. That would cover 18months since you first tested.

In the future in cause of any illness do mention to your doctors that you have this condition so that they can be cautious with the medications they give you. I hope I have cleared your doubts. Feel free to follow up with any further queries.

Thankyou


Patient replied :

Thank you. I tend to get a lot of stress from thinking about my health. Besides follow up blood work, is there any other tests I need?


Expert:  Dr. Deepu Sebin Sebastian replied 3 Days.

Hello,

This does not affect your health in anyway. So there is no reason to worry. No other blood tests are really necessary. You can go for repeat testing of LFT after 6 months to monitor how the Bilurubin levels are. Other that this (and the ones mentioned in the first consult) no other tests are really necessary.

Wish you good health
Thank you


Patient replied :

So in conclusion, you think if I had/have something wrong with my liver, gallbladder,pancreas, it would've showed in the bloodtest or ultrasound. Thank you


Expert:  Dr. Deepu Sebin Sebastian replied 2 Days.

Yes exactly. If there was something other than Gilbert the other blood tests (especially the AST and ALT) and ultrasound would have showed some abnormality. However it is important that you followup with LFT . Thank you


Patient replied :

That sounds good. One final question. I have read that too much copper ( wilsons disease) or iron over load can cause liver issues. Should I be concerned about those or would liver function tests have shown something ( like elevated ast / alt ) for example? Thank you


Expert:  Dr. Deepu Sebin Sebastian replied 1 Day.

No you need not be concerned at this point. There will be symptoms in Wilsons and in many cases of Iron overload. Other LFt values like AST, ALT, ALP may be raised. And most importantly the Bilurin is not going to get normalise its own in any of these conditions. (like what happened in your case). That is why you need not be worried about this.

Hope this helps
Thank you


Dr. Deepu Sebin Sebastian
Category: Select Speciality
Experience: 
MD, Internal Medicine - Stanley Medical School
Medical School - MBBS - Govt. Medical College, Kottyaam

Diagnostic Prediction - Stanford School of Medicine
Received Specialty training in Critical Care, Cardiology, Neurology, Gastroenterology, Nephrology from Stanley Medical College and in Endocrinology, Rheumatology.

Hematology and Geriatrics from Madras Medical College.
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