How
can you differentiate Gilbert’s syndrome with Jaundice!!! Is Gilbert’s Syndrome,
a Jaundice?
Jaundice:
Jaundice is a condition in which the patients posses
yellowish pigmentation in skin, mucous membrane, conjunctival membrane over the
sclera and in urine, which is due to the hyperbilurubinemia[1]. This
hyperbilurubinemia cause increased levels of bilurubin extracellular fluid.
Normal bilurubin level in body not exceeds 1 mg/dL but in case of jaundice it
exceeds 1.8 mg/dL[2].
Bilurubin is the by product of break down
destruction of Red Blood Cells (RBC). The haemoglobin released from destructed
RBC, splits into heame portion, which undergo chemical conversion and forms
bilurubin[3]. Unconjugated bilurubin in the blood is excreted by
liver in the form bile. Liver excrete bilurubin in the form of bile. Disturbance in normal metabolism and
production in bilurubin results in jaundice [4].
- conjunctival membrane over the sclera shows yellow pigmentation[5].
- Yellow pigmentation in urine [6].
- Yellow skin [6].
- Yellow pigmentation inside mouth [6].
- Pale or clay coloured stool [6].
- Vomiting [6].
- Abdominal pain [6].
Diagnosis:
- Bilurubin blood test [6]: To check the bilurubin total (reference range 0.2-1.3mg/dL), bilurubin direct (reference range 0.0-0.25 mg/dL), bilurubin indirect (reference range 0.1-0.8mg/dL). If the range exceeds the reference range then the condition is hyperbilurubinemia.
- Hepatitis virus panel [6]: To look for liver infection, detect current or past information about hepatitis A, hepatitis B, hepatitis C through series blood test.
- Liver function test[6]: To determine how well the liver is functioning, the various tests come under are:
- Total
bilurubin: ref: range 0.2-1.3mg/dL.
- Direct
bilurubin: ref: range 0.0-0.25mg/dL.
- SGOT/AST:
ref:
range 10-42 IU/L.
- SGPT/ALT:
ref: range 10-40 U/L.
- Alkaline
phosphate (ALP): ref: range 0.0-258 IU/L.
- Total
Protein: ref: range 6.6-8.3 gm/dL.
- Albumin:
ref: range 3.5-5.0gm/dL.
- Globulin:
ref: range 2.5-3.5gm/dL.
- Complete blood count [6]: To check whether the patient is anaemic or not.
- Abdominal Ultra Sound [5].
- Abdominal CT scan [6].
- Liver Biopsy [6]: Which help as to diagnosis of many liver diseases, especially important in the case hepatitis C infection.
- Cholesterol level [6].
Gilbert’s
Syndrome:
Heriditary[7] mild disorder in liver which cause blood stream rise in bilurubin, liver enzymes are abnormal[8]. This autosomal recessive condition is characterized by intermittent jaundice in the absence of hemolysis or underlying liver disease [9, 10].
This is due genetical mutation of promoter region of gene for the enzyme UGT glucuronosyltransferases, important for bilurubin metabolism [11].
Symptoms:
- Mild jaundice may appear due to exertion, fasting, stress and infections [12, 13].
- Disability to detoxify certain drugs.
- Elevated blood bilurubin cause yellow pigmentation of eye [11].
- Fatigue [14].
- Yellow pigmentation in urine.
Diagnosis:
Treatement:
There is no need for treatment, and the prognosis
(outlook) is excellent since it is a hereditary disease and it is a syndrome
[11].
Conclusion:
Gilbert’s Syndrome is only a syndrome and is
genetically acquired and which did not have any treatment. Only thing that we
can do is to avoid stress and exertion. Avoid fasting eat food according to the
regular time. GS is characterised by rise in bilurubin above the normal. In
case of jaundice which is due to disturbance in normal metabolism and
production of bilurubin. Jaundice may adversely affect the functioning of liver
and sometimes cause inflammation. Characterised by hyperbilurubinemia,
vomiting, loss of appetite, abdominal pain, and yellow colour to the urine,
sometimes may cause inflammation of liver. Proper treatment is given to this
condition. Chronic condition may cause hepatitis and be fatal.
Reference:
- Click, R; Dahl-Smith, J; Fowler, L; DuBose, J; Deneau-Saxton, M; Herbert, J (January 2013). "An osteopathic approach to reduction of readmissions for neonatal jaundice". Osteopathic Family Physician 5 (1): 17. doi:10.1016/j.osfp.2012.09.005. www.osteopathicfamilyphysician.org/article/S1877-573X(12)00187-6/abstract
- Silbernagl S, Despopoulos A (2009). Color atlas of physiology (6 ed.). Thieme. p. 252. ISBN 978-3-13-545006-3.
- www.medicalnewstoday.com/articles/165749.php
- www.nlm.nih.gov/medlineplus/ency/article/000301.htmhttp://www.medicinenet.com/gilbert_syndrome/page2.htm
- Kasper et al., Harrison's Principles of Internal Medicine, 16th edition, McGraw-Hill 2005
- Boon et al., Davidson's Principles & Practice of Medicine, 20th edition, Churchill Livingstone 2006
