Hyperbilirubinemia
Download
Report
Transcript Hyperbilirubinemia
Hyperbilirubinemia
Sara Pape-Salmon NP(F)
VIHA, Mental Health & Addictions
Services
April 13, 2010
Demographics
H.H.
64 year-old female
Eastern European descent
Resides in Victoria
PMHx:
Paranoid schizophrenia
Obesity
Over-flow incontinence likely
PSHx:
Tubal ligation
Medications & Allergies:
Loxapine 25 mg OD
Multivitamin
Folic Acid
Vitamin B12
NKDA
Social Hx:
Lives alone
No ETOH, currently non-smoker (remote
20 yr hx), no IVD/illicit drug use
Receives intensive MHAS out-reach
services
Family hx is not known
Chief Concern
Serum icterus, slight (incidental finding)
Fatigue?
Lab Findings:
Serum indices = slight icterus
ALT, AST = normal
Total bilirubin = high (29 umol/L)
Conjugated bilirubin = normal (3 umol/L)
? Unconjugated bilirubin (was not
obtained/tested)
Dx & Pathophysiology
Gilbert Syndrome
Pathophysiology
Most common inherited cause of unconjugated
hyperbilirubinemia (recessive trait UGT1 gene)
Underactivity of the conjugating enzyme
system (diphospate glucuronyl transferase)
Benign condition
Physiology Review
Bilirubin conjugation
Bilirubin = byproduct of RBC destruction
In plasma bilirubin binds to albumin & is lipid
soluble = “unconjugated bilirubin”
Unconjugated bilirubin can cross biologic
membranes
Physiology Continued
Bilirubin conjugation cont:
Unconjugated bilirubin moves into sinusoids in the
hepatocyte & joins with glucuronic acid & becomes
water soluble = “conjugated bilirubin”
Conjugated bilirubin, now H2O soluble, can be
excreted
Excreted in urine (sm amt as urobininogen) and in feces
(mostly)
Signs & Symptoms
Usually dx around puberty
Often precipitated by intercurrent illness,
dehydration, menstrual periods, stress, fasting
states
Abdominal cramps
Fatigue
Malaise
Mild jaundice intermittently in some
Many people are asymptomatic
Differentials
Hemolysis
Hematoma
Rhabdomyolysis
Acute or chronic liver disease
Infections
Cardiac disease
Medications (e.g. Atazanavir, probenicid, some
antibiotics)
Thyrotoxicosis
Laboratory Studies
CBC including retics and blood smear (exclude
hemolysis, RBC abnormalities)
Lactate dehydrogenase
LFT’s
Conjugated and unconjugated bilirubin
Dx: Normal CBC, retic, blood smear, LFT’s, +
unconjugated hyperbilirubinemia on several
occasions, + absence of other disease process.
Treatment
Reassurance of benign nature
Normal life expectancy
No dietary or activity restrictions
No medications for treatment
References:
McCance, K.L., & Huether, S.E. (2002).
Pathophysiology: The biologic basis for disease in
adults and children. (4th ed). Mosby Inc. St.
Louis, Missouri.
Mukherjee, S. (2009). Gilbert Syndrome. Found
on-line at
http://emedicine.medscape.com/article/176822overview.