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`HEALTH CHECK UP' OR `INCIDENTAL' HYPERBILIRUBINAEMIA
OP KAPOOR
Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.
I still find that many family physicians are not very conversant with `benign' hyperbilirubinaemia. Such patients are labelled as having liver disease and suffer, in addition the expenditure and torture of the investigations.
I thought of finding the above new label for this so-called illness. The problem started only after the patients brought the reports from some laboratory or a hospital to me, either as a part of a health check up, (the frequency of which is increasing in all health centres), or the patients were asked to do some blood test, which was only a part of a `profile' consisting of a number of unwanted blood tests. The family doctor suddenly sees a raised level of bilirubin and pronounces a liver disease. Next time, make sure that you look at the levels of SGPT/GGT before pronouncing a liver disease. Only if the levels of SGPT are increased significantly (preferably 3 to 5 times), should a diagnosis of liver disease be thought of. Alternatively, if the GGT or Serum alkaline phosphatase level are elevated out of proportion to SGPT, a cholestasis can be diagnosed, the site of which will have to be investigated.
In patients with normal or near normal enzymes, the diagnosis of benign hyperbilirubinaemia should be made. In case the bilirubin is of indirect type (urine shows no bile pigment) Gilbert's disease should be diagnosed. But, if the bilirubin is of direct type (urine shows bile pigment), the common diagnosis of BRIC (benign recurrent intra-hepatic cholestasis) should be diagnosed. When alkaline phosphatase level is also raised, remember that, in these benign (sometimes familial) patients, the levels of bilirubin can rise in any concurrent illness or in any person, who is fasting for any reason.
Some years back, the population suffered the psychological trauma of liver diagnosis, much less, because then the doctors did not have an opportunity to see so many blood profile reports done on automated machines, as frequently as we see them today.
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