Elevated bilirubin and contradictory diagnosis. Worried.

Hello!

I am 45 years old male. I had been a intense social drinker (mainly weekend) many year but in last 3 year I increased my alcohol consumption. I drank 4 days in week often a lot.

One month and half ago, after severals days that i drank a lot, I felt a mild abdominal pain in right side. This pain decreased during a week, but after christmas days, when I ate a lot (But I did not drink too much alcohol), this pain pain appeared again and was moderate or strong accompanied by weakness. I think that my urine was darker during some days. I have not gone back to drinking alcohol since then. This more intense pain disappeared in one to two days, but a discomfort or mild pain remained.

I visited a doctor after the more intense pain and did me a blood test. This test was done about 3 weeks after inicial mild pain and 10 days after the more intense pain. The blood test showed that my liver enzymes was at normal, good leves, as well as other indicators. But total bilirubin level was high, 1.8 (1.1 unconjugated and 0.7 conjugated). Normal is under 1.2 (0.8 Un/0.3 Con). He did me another blood test three days later an enzyme remained at normal leves and total bilirubin were 1.4. And urine test said that it was normal (no bilirubin). My doctor says me that probably I expelled a small gallstone and my liver is fine. An ultrasound was done and did not show more stones.

The doctor sent me to a specialist for security and then this specialist told me that he did not think that I expelled a gallstone!!!. He thinks that I have Gilbert's syndrome and also that my liver is fine, no hepatitis, fatty liver, cirrhosis or other disease. But i read that in Gilbert's syndrome only unconjugated bilirubin is elevated, not both. One doctor says gallstone, other Gilbert's syndrome!!!

I do not know what to think and I'm very worried. I have read that only a advanced liver disease or cirrhosis, can raise direct and indirect bilirubin without elevating enzyme levels. Could I have such an illness if my liver enzymes and other indicators are fine?. I have no more symptoms and the discomfort has almost disappeared, but I do not know what to do, i think that with my drinking history, I can have a liver disease and nobody is diagnosing it.

Post Edited (Peter72) : 2/3/2018 2:52:26 AM (GMT-7)

ppm guy said...
Hi Peter72 and welcome,
The gallstone is not likely, since your ultrasound was normal, and your bilirubin remained elevated..

Gilberts is more likely,since your liver function is normal, except for your bilirubin..The high unconjugated bilirubin is the result of your liver having trouble making an enzyme (glucoronyl transferase).. this enzyme makes your bilirubin water soluble, so you can pass it thru your urine..

Gilberts can also cause some of your symptoms you described. I have not heard of Gilberts being a serious problem.

let me know how things work out

Thanks for the reply. Gilberts is not a serious problem but I have read that in Gilberts only indirect bilirubin is elevated. And I have both elevated, but conjugated is comparatively higher, unconjugated is only a little high. This is very strange and I am very worried.

Maybe not drinking would be a good idea. I did that and have never regretted it. Perhaps with the Gilberts drinking is just too much. You can get a really good feeling from being really healthy. On a side note, when I got the worst liver damage and was the sickest my ALT was zero. My liver could not repair ir make enzymes. So low can also be bad. If you are really worried seek a second ooinion from a liver specialist if you can or a good gi. It could be your gi tract that caused the pain.