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Fatigue, No Fever, Done Lab Test, Elevated Bilirubin, Probable Gilberts Syndrome, Normal CT Scan

Posted on Sat, 21 Jul 2012

Question: Hello,

I have been feeling really fatigued, tired, lately and having total body aches kind of like flu symptoms without running a fever. I check my temperature everyday and never run above a 97.5. I have had some lab work ups that are attached and wondering if any of my symptoms could be related to these lab results.

One thing to note in the lab reports is the elevated billirubin. My bilirubin has been at that level for 8-9 years now and the doctor told me it was probably Gilberts Syndrome as I have had a blood smear related to it and a Abdomen Ct Scan that was normal.

Answered by Dr. Rakesh Madhyastha (16 minutes later)

Hello

Thanks for the query

I have gone through your results in detail and I would like to know a few things in order to come to a good conclusion

1. Do you drink? If yes how often and how much?
2. Are you on any medications? Pleas list them all
3. Have you undergone ultra sound abdomen? What does it say?
4 have you received treatment for low Vit d

Please get back to me with the answers, I am awaiting your reply

I wish you good health

Regards

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

Follow up: Dr. Rakesh Madhyastha (1 hour later)

I do not drink. I stopped recently. My liver function test only were high recently as they have not been in the past.

I have never underwent an ultrasound of the abdomen. My doctor told me that my Cat Scan of the Abdomen was sufficent as that would have showed any abnormalities.

The medications I am presently on is Vicodin, once a day for lower back pain.

I have not recieved treatment for Vitamin D. Two days ago I started taken 10,000iu Vitamin D3 daily.

Follow up: Dr. Rakesh Madhyastha (17 minutes later)

Please see the attached. I had an abdominal CT done recently.

Follow up: Dr. Rakesh Madhyastha (21 minutes later)

Also please see the lab that was done on March 26, 2012 that was uploaded. AST and ALT were normal.

Other medications I have been on and just got off is Biaxin and I take Xanax regularly.

Answered by Dr. Rakesh Madhyastha (15 hours later)

Hello

Thanks for replying with reports

I see that your ct scan and the previous liver function tests are normal.
The abnormal reports are the liver function test, cholesterol and Vit d levels.

The most common complaints of people with Vit d deficiency is gen body ache and easy fatigueablity with almost always improves slowly with replenishment. Continue the Vit d supplements as prescribed.
For your altered lipid profile i recommend you to restrict oily foods like cheese, butter, chips and also go for brisk walking for 30 min a day for 6 to 7 days a week. It should help you increase your hdl and also lower the total cholesterol and triglycerides. I recommend you repeat the lipid profile after 3 months. If it still persists to be deranged you will have to be on lipid lowering agents

For the deranged liver function test you will have to undergo further investigations like usg abdomen to rule out hepatitis, blood tests for hepatitis b and c. I strongly recommend you see a Gastro enterologist in regards to this as soon as possible.

I hope I have answered your query. Please let me know if you have further doubts I will be happy to help

Regards

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

Follow up: Dr. Rakesh Madhyastha (1 hour later)

I seen a gastro doc for the abnormal bilirubin and she ordered the blood smear report. Once the blood smear report came back she was not worried and she said she wanted to make sure that it was not the direct bilirubin as direct often could suggest liver disease but in my case the indirect was raised therefore causing the total to be raised. She said an elevated indirect bilirubin doesn't suggest liver disease but she wanted to order a blood smear to confirm. Does that sound right?

Also how much daily Vitamin D3 to supplement would you recommend to raise Vitamin D levels? I have read 5,000 iu all the way up to 10,000 iu. I am taking these on my own?

Answered by Dr. Rakesh Madhyastha (11 hours later)

Hello

It is true that direct bilirubin signifies liver disease than indirect bilirubin however your sgot and sgpt is also raised which shows that there is some liver involvement as well that is why you should be evaluated for the things I have mentioned in the previous post.

Vit d 3 is usually given at 10,000 iu daily for a month.Confirm with your physician before starting the regimen. You will have to repeat the Vit d levels after 12 weeks.

I hope I answered your query. Please accept my answer if you have no further ones

I wish you good health

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

Follow up: Dr. Rakesh Madhyastha (39 hours later)

I had one last question about my Cat Scan abdomen and pelvis results. As you see the results indicate that everything is normal. Should I be worried that they missed something and can you see everything really good on a cat scan without contrast?

Answered by Dr. Rakesh Madhyastha (9 minutes later)

Hello

Thanks for the query

Cat scan is a good scan to screen most pathologies if something is found in cat scan an MRI would have been ordered so it is least likely that something is abnormal anatomically

I hope I have answered your query, if you have no further ones please accept my answer

Regards

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