Bilirubin question

I'm not sure, but I have seen my dad's bilirubin as high as 4.09. Which I think is off the charts.

Thanks :)

What I'm confused about with my sisters results is the way they increase hand in hand.

Ok,,,, lets say somethings blocking.... then would ONLY the direct rise? or indirect ALSO rises?

Looking back over the previous few blood tests:

June 13 - Direct was 22% of total (D 0.16/I 0.56 Total - 0.72)
Sept 13 - Direct was 41% of total (D 0.52/I 0.74 Total - 1.26)
Jan 14 Direct was 19% of total (D 0.23 I 0.96 Total - 1.19)
March 14 Direct was 24% of total (D 0.12 / I 0.37 - 0.49)
June 14 Direct was 20% of total (D 0.29 / I 1.14 total 1.43)

Her skin is (normally) super white but even these lower levels make her jaundice seem quite noticeable.

Her results yesterday showed a jump in ALT back to 58 though it had reduced in previous 3 tests to 41, 25, 24.

Yesterday-
AST 33
ALT 58
Phosphate - 68
GGT - 11
albumin 4.8
Glob 2.2
LDH - 165
INR - 1.09 (was 1.2)

Urine - negative for bilirubin. Urobilinogen 0.2 (was 1.0)

She has discomfort every day under rib area and is extremely sensitive to the food that she eats.

Post Edited (daveypoo) : 6/8/2014 5:20:22 AM (GMT-6)

If Gilbert's were in play, her total will progressively get higher due to the indirect portion not being excreted either through: the liver - it's not doing its job conjugating, or the kidneys - indirect's not water soluble. The bilirubin needs to go somewhere and the two typical exit routes from the body are not available, so it progressively builds up. This is what causes the standard jaundice people typically see but this will not occur until the blood serum bilirubin levels roughly reach around 2.5 or higher.

This is not what the records indicate. The levels are only slightly elevated and her liver is conjugating or you wouldn't detect much direct at all and the indirect would progressively buildup. There is one incidence of a very high direct/total ratio and a pattern of what appears to be mild, periodic bile flow obstruction - a kind of ebb and flow. Her liver isn't very likely to be changing it's efficiency in the conjugation process itself so this still points to some type of mild obstruction as a possible cause.

How are her eating habits? Any "starvation" diets being used along with normal eating to maintain weight, or just a lot of just nibbling here and there? Periods of digestive inactivity can lead to "sludge" buildup within the bile plumbing and can even fill the gallbladder on occasion. This slow moving sludge can cause a kind of "ebb and flow" condition.

Again, this is just a guess at at the possibilities here. Anything of real significance should be taken to her doctor for consideration. We're just here to help.

Btw, I noticed your other post about lying down and then getting up. This seems much more like a vascular, perfusional phenomenon. Again, just a guess.

bblbt: Thanks for the technical info...as a caregiver and moderator here, I appreciate those with unique knowledge are willing to share it. Mama Lama

Interesting to note that extreme dieting had occurred recently. You listed June 13, Sept 13 ... June 14 - was the first data back a year ago in 2013? Also, was the date of the urine's urobilinogen 1.0 about the same time as the high direct/total ratio incidence, Sept 13? De-sludging (for the lack of a better work) will happen naturally by itself but this will take time and following a disciplined diet with a relatively normal eating frequency will help. This "exercises" the gallbladder instead of letting it lay around acting like a lazy bum with nothing to do.

Good luck, Davey.

MamaLama, I hope to add value when I can and you have a great site running here. I know I've benefited by it immensely as many others have. Thank you for your great work. Let me know if I'm wasting too much space on the technical end of things (wrt the flavor/purpose of the site). I'm the end result of what happens when liver disease picks on someone who's spent their entire career doing advanced research - just never on biological systems, but that sure has changed now.

Ursodiol might help. Ask your doc.

bblbt-the more technical, the better. It's good to learn from each other.

@bblbt,

may i ask you about my bilirubin elevations?

since one year my bilirubin is going up and down from 1.0-2.0.the direct bilirubin was always around 30% of the total bilirubin.
my last labs showed my bilirubin spiked up again to 2.3 direct is 0.3.
gilbert was excludet with a genetic test.
all other labs are normal.
but i often have pain in the stomach and iam very very sensitive to food.

any idea if i should be concerned?