Liver Disorders Community
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Avatar universal

Elevated Bilirubin (both) but normal liver enzymes

I have High bilirubin (both direct and indirect) but normal liver enzymes. Normal abdominal ultrasound (no gallbladder stones found, normal liver size).
MRI (Abdominal with Contrast) showed mildly enlarged liver with pronounced low signal on the T2 WIs (suspected hemochromatosis, but blood Transferrin saturation and Ferritine Serum were both normal).
Also Abnormal Protein/Albumin/AG Ratio (High/High/Normal to Normal/Normal/High).

I'm very thin (50 kg/110 pounds). What I "suffer" from are mostly IBS-like symptoms, severe bloating that makes it hard to breath, usually 1-2 hour after breakfast and stays the whole day (I tested negative for H. Pylori though, rarely used NSAIDs the past decade). I have chronic constipation, occasional pain in right side (2 months ago, the pain was so severe, but turned out to be a spontaneous collapsed right lung, hopefully not related to it!).

Medication: Librax for IBS, Simethicone for bloating, L-Glutamine 5g/day, if needed Antacids and Senna.
Nicotine gum (Nicorette 4mg), 2-5 quarter cups of coffee a day (drink few sips only).

Detailed tests:
**Bilirubin (Total) 3.25 mg/dL, after 2 months 2.73 mg/dL (*ref 0.2-1)
**Bilirubin (Direct) 0.47 mg/dL, after 2 months 0.42 mg/dL (*ref 0-0.2)
- ALT 28 U/L, after 2 months 17 U/L (*ref < 50)
- AST 27 U/L, after 2 months 20 U/L (*ref < 50)
- GGT 27 U/L, after 2 months 22 U/L (*ref up to 55)
- Alkaline Phosphatase 52 U/L, after 2 months 41 U/L (*ref 30-120)
**Total Protein was high 8.9 g/dL, but after 2 months 7.1 g/dL (*ref 6.6-8.3)
**Serum Albumin was high  5.6 g/dL, but after 2 months, 4.8 g/dL (*ref 3.5-5.2)
**A/G Ratio was good at 1.7, but after 2 months high at 2.1 (*ref 1.0-2.0)
**Microalbumin random sample  146 mg/g creat (*ref 0-30 Normal, 30-300 Microalbuminuria)

Normal blood picture
Normal urine analysis (also bilirubin absent).
Normal inflammation markers: ESR 3 mm (*ref 3-12), CRP 1.1mg/L (*ref up to 5.0)

Any help please, thanks.
1 Responses
Avatar universal
Fortunately the majority of your liver numbers look good. And you don't indicate anemia since you've stated that your blood numbers are normal.

Have your doctor's looked into whether you have Gilbert's syndrome? It seems that your liver is functioning correctly but it is just having trouble in the conjugation processing involving your indirect Bilirubin. You do not appear to have any bile blockage since your Alp and direct Bilirubin levels are normal.

Let us know what your doctor finds out. And sorry I was late in responding, my doctors have been keeping me busy lately.
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