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Dr. Andrew Rynne

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Diagnosed with fatty liver, Have high bilirubin level. Looking for suggestion

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Dr. Das Arindam

General & Family Physician

Practicing since :2008

Answered : 1416 Questions

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Posted on Sat, 5 Jan 2013 in Liver and Gall Bladder
Question: Hello Doctor,
I have been diagnosed with fatty liver.My bilirubin was quite high in october but reduced to normal level in november. Its again shoot up now. I am not drinking alchol for last 3 after diagnosis.Please find below my LFT results from last 3 months. Please advis

Date     Protein      Albumin     Globulin     ALP     ALT(SGPT) AST(SGOT) CGT Bilirubin
12 Oct     78     55     23     51     32          35      50
                                        
14 Oct     77     49     28     62     54     32     45     44.46
                                        
20 Oct     81     4.9     32     69     50     22     43     27.3
                                        
                                        
26 Oct 81     54     27     55     20          28     26
                                        
                                        
9 Nov 73     51     22     49     17          21     21
                                                                           
11 Dec 73     50     23     57     13          19     28
doctor
Answered by Dr. Das Arindam 1 hour later
Hello,
Thank you for posting a query.

After reading your reports, some points I want to highlight. You told that you have fatty liver. Fatty liver is a benign condition. Here usually no gross abnormality arises. In you case, bilirubin is always high >20. But, the liver enzymes are not elevated upto the level which is expected in a patient with this bilirubin level. So, there is some discrepancy. I mean, you have high, fluctuating bilirubin level ranging from 21 to 50, with mild increase in ALT and AST.

The above discussion sounds like presence of a congenital disease, that is XXXXXXX syndrome. For confirmation there are two tests. One is to do a bilirubin test before and after fasting for 1 / 2 days. Second is to do a DNA PCR test to detect UGT1A1 mutation. This test is confirmatory.

There are some other disease which may also present with this type of features. These are hemolytic disease, viral hepatitis, cholestasis and some other congenital disease. To differentiate between these, serum LDH levels, serological tests for hepatitis viruses.

Lastly, Gilberts disease is a high possibility, consult with your treating doctor about it.

Hope this information suffices. Let me know, if you have any more question.

Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Das Arindam 22 hours later
Thanks doctor, Hepatitis virus test was negative. Consulting doctor also feels it may be XXXXXXX syndrome; he has not done the test you have prescribed. I checked an LFT done in early week of September, Bilurbin was 18 which was normal. I am concerned what would have influenced the increase the Bilurubin which was lowered to 21, one month back. Also the haemoglobin and red blood cell count has been decreasing consistently. Some of the physical symptoms i experience are

•     Pain in the upper right side and back upper right side.
•     Nausea in the morning once in a while.
•     Headache
•     Lost 8 kg in 2 months
•     Dark yellowish urine with strong smell
•     Itching
•     Digestive issues/ Gastric

What restriction should I have on diet? Can I have pulses (lentils), Oats, soy milk? Please advise.
doctor
Answered by Dr. Das Arindam 3 hours later
Hello,

Thank you for writing back.

I can understand your concern.

But, I have already told you about the problem. The symptoms you described are suggestive of hyperbilirubinemia. So, as I previously told, consult with your treating doctor about the genetic abnormality.

In case of diet, you should avoid alcohol, oily food, fatty foods like butter, etc. You can take the pulses sometimes but not regularly.

The red blood cells are within normal limit. If there was any abnormality, then other parameters should also reflect that. Here all are within normal limit. So, I think, you have nothing to worry about the red blood cells.

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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