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Asymptomatic jaundice after fasting: a diagnostic dilemma
H R Wright1, A J Gear, R F Morgan
1Department of Plastic Surgery, University of Virginia School of Medicine, Charlottesville 22908, USA.
The Journal of Emergency Medicine
|December 24, 1997
Summary
Gilbert's syndrome, a common cause of mild jaundice, was diagnosed in an 18-year-old female using specific bilirubin and bile acid tests. This case highlights diagnostic methods for this benign condition.
Area of Science:
- Biochemistry
- Clinical Medicine
- Diagnostic Methods
Background:
- Gilbert's syndrome is a common, hereditary condition characterized by intermittent, mild unconjugated hyperbilirubinemia.
- It is often asymptomatic and typically diagnosed incidentally in adolescents and young adults.
- Understanding diagnostic markers is crucial for differentiating it from more serious liver conditions.
Observation:
- An 18-year-old female presented with asymptomatic jaundice after a period of fasting.
- The patient was referred for specialized evaluation and treatment at a regional medical center.
- Fasting is a known trigger for exacerbating symptoms in individuals with Gilbert's syndrome.
Findings:
- Diagnosis was confirmed through fractionation of serum bilirubin (unconjugated and conjugated) using alkaline methanolysis.
- Thin-layer chromatography was employed for precise separation and analysis of bilirubin fractions.
- Analysis of fasting-state cholyl conjugated bile acids further supported the diagnosis of Gilbert's syndrome.
Implications:
- This case underscores the importance of specific laboratory analyses in diagnosing Gilbert's syndrome.
- Accurate diagnosis prevents unnecessary investigations and patient anxiety associated with jaundice.
- The study discusses established and effective methods for identifying Gilbert's syndrome, aiding clinical practice.