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“You can get past the dead end. You can break through the ceiling. I did and so have countless others.”

Clinical Pearl Wednesday #161

Liver on yellow background

Have a patient with an elevated bilirubin found incidentally through routine bloodwork? Don’t freak out, this is more common than you think!

Many patients will have a high baseline bilirubin and be completely asymptomatic and have no significant underlying pathology. Many will have a condition called Gilbert’s syndrome and not even know it!

Gilbert’s syndrome is a common, harmless liver condition where the liver doesn’t process bilirubin properly. It is usually asymptomatic and affects men more than women. I see harmless elevated bilirubins in many of my men’s health patients all the time! And it is usually found incidentally through doing routine labs…

I have dozens of patients who have had an elevated bilirubin on every single lab draw for the past 3 years. Ultrasound is negative and they are completely asymptomatic. Diagnosis of Gilbert syndrome is usually done clinically if the patient has a normal CBC, normal LFTs, and has no symptoms, therefore an ultrasound is not necessary in many cases.

So, the next time you see an elevated bilirubin that was found on routine lab work in an asymptomatic patient, don’t freak out! Just recheck the bilirubin in a month and if their blood counts and LFTs are normal, then monitor the patient and consider ordering an ultrasound if there is any concern.

3 Responses

  1. I agree with many practitioners order way to many test period. Most do not have the experience or knowledge of DD and complete PE. With this lack of knowledge is to order all kinds of test to cover this lack of knowledge. See this a lot within the VA health system.

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