sligh biliruben elevation

[katona]

hi doc,

my question is: would a 2.3 biliruben make me feel light headed, dizzy, unstable, short of breath...and give an overall very ill feeling, loss of appetite low grade headache (for weeks now), ending up in emergency room from feeling so sick. after running a bunch of test the er doc said that all my symptoms were from the elevated bilirubin. is that possible? he has me going to a gi now for follow a up.

[billyqureshi]

i dont mind looking through your results for you however theres just one thing, in the uk our labs use different units to your labs and so for me to formulate some differentials i would have to first find out which units these results are reported in, and then convert them to uk units so they make sense to me. the alternative, as boron asks, is for you to write high low or normal next to each one and if abnormal, right the range.
thanks
billy
junior doc

[boron]

Would you mind to add "normal values" to your results?

[katona]

thanx again doc for writing back...

here are my blood test figures:

lung ct scan=negative

bun=13mg/dl
creat=.99
gfr=>60
bun/creat ratio=13.1
sodium=135(mmol/l)
chloride=96
co2=23
anion gap=16
protein, total=7.7(g/dl)
albumin=4.8
glob=2.9
alb/glob ratio=1.7
calcium=10.7
alk phos75
ast=57
ast=54
bilirubin=2.3
a1c=10.2

urin color=normal, clear
spec grav=1.013
urine ph=6.5
blood, protein=neg
glucose>1000
keytones=small
urobilnogen=norm
bile, urineneg=neg
wbc, rbc, urine=none
epith cells=none
bacteria, urine=none
hyaline cast=none

wbc=9.6(k/mm3)
rbc=5.57(m/mm3
hemoglobin=16.8(g/dl)
hematocrit=48.6
mcv=87
mch=30.1
mchc=34.5
rdw=12.9
platelet count=353
mpv=10.9
seg neutro=83
lympho=11
momo=5
eosinoph=1
baso=0
absolute neutro=7.9
absolute lympho=1.1
absolute eosiph=0,1
asolutemono=0.5
absolute baso=0.0
amamylase=28

creat urine, random=39
microalb=6
microalb urine, normalized=15

do not see 'serum cortisol'. what does that do?

thanx again for looking doc. if there is anything more specific, please ask, and i will try to get it.

[billyqureshi]

to be perfectly honest katona, your symtoms are so vague and non-specific in nature that it would be impossible for me to attribute them to liver disease. also the fact that your lfts are not particulary impressive makes me think that they are more due to the fatty liver. your hepatitis serology looks good to me so i am not worried about that.
to find a cause for your symptoms, we need to step back from the whole thing and start with basics - full blood count (? anaemia , will rule out haematological nasties) Urea and electrolytes (? renal impairment) Thyroid function (? hypothyroid) serum cortisol, chest xray etc etc depending on the specific symptoms you are having.
im sorry i cant be of more help but theres just so much that could account for feeling a bit **** athat it would be unfeasible to go through it all here now.

[katona]

thanx doc for your response,

the bilirubin is 2.3 mg/dl (as the report reads).

the hep b i described, i must have had 20 years or more ago (i have only been w/ my wife since, and i don't use drugs). the hep tests results are as follows:
hep b surface ag = non reactive. hep a igm ab = non reactive. hep b core ab igi = non reactive.hep c ab result = <0.02. hep c ab interp = non reactive. they also took urine and blood cultures, the jury is still out on those (takes 72 hrs). also, my calcium was a little hi on one test = 10.7mg/dl. but then latter went down to 9.5
i have had fatty liver for at least 15+ years according to past ct scans.
my alt is at 57 and ast at 55. i mean these numbers are unremarkable...aren't they? would i get so sick from what these numbers are? i am able to eat a little now, but still am dizzy lightheaded, kind of in a dream state and malaise.
what other things could cause this? i have no respetory congestion (just easily out of breath). no diarhea or fever (indicating viral infection). it's been three weeks now. what gives doc. could it truly be my liver?
oh, one other thing...i have no acute pain when pressed on abdomen areas.

[billyqureshi]

firstly, your bilirubin level is not high, but it all depends on the units you are using! normal is 3-17 micromols per litre, and 2.5-10 mg/litre.
you say you have had hep b in the past. as im sure you know hep b, although some patients do clear the virus completley in the early stages, most do not and enter a chonic disease. chronic hepb has 3 stages in its natural history. during the second stage, the immune clearance stage, the transaminses (specifically the alt) can begin to rise but the hep B DNA levels fall. this stage can last months to years.
when you say your hepb test came back negative, we need to know exactly what antigens / antibodies were checked because it is not as simple as positive or negative when you have had the disease in the past. your symptoms may well be in fitting with the course of chronic hepb.
you also mentioned you have fatty liver and history of alcohol excess. if fatty liver is all that you have, then this is early in the course of chronic liver disease if it were associated with alcohol only, but the hep complicates things here.
the symptomsyou decide aer very non specific and do not suggest liver failure any more than they suggest lots of other generalised diseases - i could think of atleast 15 diseases of the top of my head that would account for the symptoms you have listed. but as the previous poster says, the bilirubin , assuming it is actually high, would not produce these symptoms. as you are probably aware, one of the complications of chronic hepb is hepatocellular carcinoma, howeverthis is a late complication and it is low down on the list of possibilities and im confident your physician's initial investigations will have ruled this out. as i say, there are MANY causes for your symptoms so dont jump to conclusions.
i hope ive helped your understanding
billy
junior doc
you certainly need more investigation by hepatobiliary specialists in order to understand what exactly is going on, which obviously i do not have the results off.

[katona]

boron, thanx for input.

my labs also came back with a slight elevation in ast = 55. evething else looked ok (i was told). i am a diabetic and have been having a hard time with my glocose levels lately too. my sugars were around 300 at the hospital.
i have a history of acohol consumtion (lots of years). i have a fatty liver and have a history of hep b (which was tested at the hospital, and came back neg).
i don't know, i feel so bad. i have never felt like this before for so long (3 weeks now).
so, you think all this is related to the liver? do you think it will eventually get better. or, do you think it will get worse (like cancer?).  
please tell me i'll be ok. i am at my witts end. i have been tied to my bed for so long now. i just want to get better.

[boron]

To be exact, your symptoms are not from elevated bilirubin, but rather from the (possibly liver) disease which causes the rise of bilirubin. Bilirubin itself does not cause any of those symptoms. Bilirubin causes jaundice and dark colored urine.

Without knowing other lab results or your medical history, it's hard to say more.