Elevated bilirubin

[Debra36]

Hi,
I am a 54 your old female and I am concerned about an elevated total bilirubin of 1.7. It was not fractionated at the time of sampling. Exactly 18 months prior my total bili was 0.4 with a direct bili of 0.12. This quadrupling in 18 months worries me. I have no symptoms other than somewhat pale stools, although they have recently gone back to normal color. My alk phos., AST, and ALT are all well normal, as is my prothrombin time. My cholesterol has jumped from 209 to 224 also. LDL- 150 and HDL- 62. I exercise and take no medications. I am 126 lbs as a result of serious dieting the last 3 months, resulting in a 22 pound weight loss. I am of European ancestors. Is it possible to be developing something like Gilbert's disease at the age of 54, or do you have to have an elevated bili all your life long for this diagnosis? What might be causing the elevated bili?
Thank you for your input.
Debra

[Debra36]

Sorry, I guess I should also have mentioned TWO YEARS ago I had a normal CT of ABD, and 3 YEARS ago a normal colonoscopy.

[Debra36]

Dr. Pho,

You read too quickly! I said the weight loss was as a result of SERIOUS DIETING. The only reason I mentioned it was so that you would understand I am health conscious.

Regarding viral hepatitis.... is that possible with the AST, ALT and, ALK PHOS all being normal? The only lab abnormality is the total bili and cholesterol.

As well, you never answered the question about Gilbert's disease occurring later in life, or must it be something all life long?  Remember, total and direct bili were normal 18 months age!

Thanks,
Me

[Kevin Pho, MD]

Before considering the diagnosis of Gilbert's disease, further evaluation of the liver and gallbladder can be done.  

I would consider imaging with an ultrasound, as well as obtaining viral hepatitis studies.  More thorough tests can include an MRCP to evaluate the biliary tree.

Especially with a 22-pound weight loss, you have to exclude cancer.  A colonoscopy should be considered as well, consider the age over 50 and weight loss.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin Pho, M.D.
www.kevinmd.com
www.twitter.com/kevinmd