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Monday, April 25, 2011

GILBERT'S SYNDROME

This common benign condition is usually first recognized in adolescents or young adults. It is more common in men and occurs in about 5% of the population.

Aetiology
The aetiology is varied but it can be inherited as an autosomal dominant. The main cause of the unconjugated hyperbilirubinemia is a deficiency of hepatic glucuronyl transferase; in some patients uptake of unconjugated bilirubin from the plasma may be impaired; in others mild haemolysis not detectable by conventional laboratory tests is present.
Clinical features
Gilbert's syndrome generally presents as mild jaundice occasionally noted after viral hepatitis from which there has been a complex recovery, or is found incidentally. Many patients have no symptoms; others suffer episodes of malaise, anorexia and upper abdominal pain, the last occasionally severe, with increase in the jaundice. These episodes may be related to infection, fatigue or fasting. Physical examination shows mild jaundice but in otherwise normal.
Investigations
Investigations indicate hyperbilirubinaemia, with no abnormality of other liver function tests.Liver biopsy is normal and should be performed only if there is clinical or biochemical evidence suggesting liver disease.
Management
No treatment is necessary.

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