Respected Doctors ,I want present a case in front of you All .47 years age executive in sugar industry. 60 kg weight ,5 feet 6 inches height ,Hindu .non vegetarian ,use to walk 3 km /day suffering from high BP & on amlodipine 5 mg ,suffering from hypocalcemia 25 hydroxy 6.nml on Cholecalciferol 60000 iu weekly for 8 week Prescribed by a professor of KGMU Lucknow ,is suffering from mild elevated serum bilirubin 1.6 & slightly up & down since one & half year .his USG normal. lipid profile normal, sugar normal ,Why serum bilirubin is elevated since 1&1/2 years .what is Dx & Rx .thanks to all .



Dear Ved Prakash, Again a good case. Thanks for so nice presentation. One should learn the art of presenting a case. This is a case of 1) HTN 2) Hypocalcemia 3) Hypovitaminosis D 4) Fluctuating Serum Bilirubin. The reason for Fluctuating Serum Bilirubin may be this may be a case of GILBERT SYNDROME. This is unconjugated Hyperbilirubinemia. Also called Familial non hemolytic birubenemia And also called Constitutional Hepatic Dysfunction. This is a very benign condition. No treatment is required. As seen from the reports the indirect Bilirubin is more than that of direct. This is very typical of GILBERT SYNDROME. Diagnosis is made by history, Physical examination Indirect Bilirubinemia. LFT Normal Normal CBP Normal Blood smear Absence of other diseases. Thanks dear ved Prakash for giving me an opportunity to answer your question.

Congratulations & thanks Sir .I salute to you,your parents and all the family members having a gems in the family .thanks again Sir.

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this patient has hypertension and vitamin d deficiency... coming to elevated bilirubin which is minimal and normal hemoglobin... what about liver enzymes...if liver enzymes are also normal,then it would be Gilbert syndrome

classic gilbert syndrome, asymptotic elevation in bilirubin on stress and levels will be below 3, so clinically not able to detect.

yes if liver enzymes are normal,a and no GI symptoms then possibly Gilbert syndrome no treatment needed.

Nice presentation Dr. ved prakash sir And Repeated my mohan sir Great Answer Explanation Thanks

Thanks a lot dear Pathak

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Mildly increased s.bill and increased indirect bill point towards gilbert syndrome

Gilbert Syndrome.No treatment.

Please check his cardiac check up base line echo and ecg. For ccf and thyroid function for hypocalcemia

TMT & 2D echo are normal.

Do elastography or jyda scan of liver it is non fatty liver disease hyda scan start okamet500 od

all are normal only s bilirubin is raised since one & half years. Respected friends.

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