My 21 year old son has elevated bilirubin levels

[randyp]

My 21 yr old son having an episode of intestinal flu had blood testing done back in May. The results revealed an elevated bilirubin count of 1.3h mg/dl and elevated amylase of 109h. As a followup last week he was retested and his bilirubin count was 2.1h mg/dl and his amylase was 102. Prior to his test he had little to eat and had also weight lifted. Another concern is that he has lost about 20 pounds over the past 4 months with no explanation. He is about 5'10" and 170 lb. and regularly jogs and weight lifts. Any suggestions.

Thanks you

Randy

[Kevin Pho, MD]

Any type of biliary obstruction can cause a rise of the bilirubin.  There are several things that can cause a rise in amylase - pancreatitis being the most common.  

First test to do would be an abdominal ultrasound.  This can evaluate the liver, gallbladder and do a general evaluation of the bile ducts.  I would also obtain the rest of the liver function tests to ensure there are no further abnormalities.  If negative,  you can consider an MRCP - which would give further detail to the bile ducts.

If all the other tests are negative, then one consideration would be something known as Gilbert's syndrome.  This is a genetic overproduction of bilirubin, and is normally benign.

You can discuss these options with your personal physician.

Followup with your personal physician is essential.

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, M.D.
Medical Weblog:
kevinmd_b

[randyp]

I'm still concerned about his weight loss, could this be attributed to a possible biliary obstruction? Also couldn't the biliary obstruction be related to pancreatitis?

Thanks

[Wools]

Our son was 22 and losing weight for no reason. This went on for 6 month to a year. Then came the yellowing of the skin. We had labs drawn and all the liver panel was high (Billi 8.0). An ERCP was then recommended. This is where I SRONGLY recommend that you go only to a large center to have tests done. We chose a small local hospital and what a disaster....The test gave him pancreatitis. After three months in ICU he recovered. He was diagnosed with a liver disease called Primary Schlerosing Cholangitis. Its a biliary disease that causes the bile ducts to scar and block. I am writing this post today not to scare you but to encourage you to get the ERCP done by doctors that do it on a regular basis (daily, not monthly).We traveled a rough road to his recovery. He is 26 today and is working and going to college. We are thankful for the wonderful medical doctors and nurses that helped him through it. We are also grateful for the wonderful lady that donated his new liver.
Organ donation is truly a donation of LIFE.....

[randyp]

A CAT scan and an abdominal ultrasound have been completed:
Cat scan:There is a mild prominence of the posterior body and tail of the pancreas without evidence of a discrete mass or peripancreatic inflammatory change to suggest pancreatitis. There is no abdominal adenopathy or ascites.

Impression: MILD PROMINENCE OF THE POSTERIOR BODY AND TAIL OF THE PANCREAS WITHOUT CT EVIDENCE OF PANCREATITIS.NO BILIARY DILATATION.

Ultra sound: The common bile duct has a normal ap measurement of .3cm. The liver is top limits of normal in size measuring 17.6*11*11.4. There may be a Reidel's lobe present. No focal masses are seen within the liver.

Impression:BORDERLINE HEPATOMEGALY. THIS MAY BE DUE TO THE FACT THE THE PATIENT HAS A REIDEL'S LOBE.

Does anyone have any comments regarding these results?

Thank you

[randyp]

Did your son have any other symtoms such as colitis or were his ALT liver enzyme elevated? These are both symtoms that are associated with PSC.

[Wools]

Our son never had an episode of colitis.  He was extremely healthy throughout his teen years. Therefore he had never had any labs drawn. His first signs were the weight loss (about 30 lbs within one year. Next was the itchy skin all over his body.
This lasted about 4 weeks. He started noticing that he was having digestive issues. Then the skin turned yellow. Within a week he had grey stools, tea-colored urine, cramping, upset stomach.  Ultrasound didn't offer any information. The URCP made him so ill as I stated before. It was two months later that it was finally diagnoised as PSC. Our biggest mistake was the ERCP done at a local hospital.  I can't stress enough how that test can make someone SO ILL.  If your son is facing this procedure.....take him to a gastro center at a large hospital.
His ERCP simply indicated a blockage of the bile duct but the pancreatitis put him in the ICU for three months. Good luck with your son. We feel so fortunate today after such a troubling year.