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Hi Dr I Have Had What I Think To Be

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Posted on Sat, 31 Oct 2020
Question: Hi Dr

I have had what I think to be gilberts syndrome, but never confirmed. As long as I can remember my levels have always waxed and waned highest being 2.2 amd asymptomatic in that aspect. Just recently I went to the hospital due to severe dyspepsia and bilirubin at that time was 2.2. I had upper egd and confirmed chronic esophagitis and antral erythema. Fast forward andi had asked my dr to follow up with hyperbilirubemia amd although ditect and indirect normal the unconjucated being on the higher end of normal at 0.74, hgb and liver function normal. Had ct scan of abd and pelvis with contrast in May 2020 and all unremarkable aside from 13 cm and mild fatty infiltrate liver. Would you consider this gilberts syndrome or is the bilirubin posaibly due to fatty liver?



Next thing is I also have a hx of premature ovarian failure and was going to be placed on Hrt, but due to coagulapathy issues on dad side of family I was sent to a hematologist/oncologist. She asked about my symptoms and i mentioned heartburn and nausea due to assumibg chronic esophagitis so over the yr I lost 6 lbs not drastic weight loss, but she ran some tests and tumor markers and all negative except for ca 19.9 which was 71 and I am beside myself nervous and scared. This along with the bilirubin looks scary, but I know that my bilirubin has really always been in the range of 1.1-up to 2. Do they have some sort of correlation,? Should I worry about the Ca 19.9 level? Like I stated earlier I had a contrast enhanced ct scan 4 months ago all normal aside from fatty liver. If i did have gilberts syndrome would.it elevate the ca level? Sorry for so many questions. I am worried about pancreas. Is this something i have to worry about and what should be the bext steo? Thank you



I dont believe it's hemolytic anemia as my ldh waa normal no other tests in this regard performed.
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Follow up: Dr. T Chandrakant (0 minute later)
Hi Dr

I have had what I think to be gilberts syndrome, but never confirmed. As long as I can remember my levels have always waxed and waned highest being 2.2 amd asymptomatic in that aspect. Just recently I went to the hospital due to severe dyspepsia and bilirubin at that time was 2.2. I had upper egd and confirmed chronic esophagitis and antral erythema. Fast forward andi had asked my dr to follow up with hyperbilirubemia amd although ditect and indirect normal the unconjucated being on the higher end of normal at 0.74, hgb and liver function normal. Had ct scan of abd and pelvis with contrast in May 2020 and all unremarkable aside from 13 cm and mild fatty infiltrate liver. Would you consider this gilberts syndrome or is the bilirubin posaibly due to fatty liver?



Next thing is I also have a hx of premature ovarian failure and was going to be placed on Hrt, but due to coagulapathy issues on dad side of family I was sent to a hematologist/oncologist. She asked about my symptoms and i mentioned heartburn and nausea due to assumibg chronic esophagitis so over the yr I lost 6 lbs not drastic weight loss, but she ran some tests and tumor markers and all negative except for ca 19.9 which was 71 and I am beside myself nervous and scared. This along with the bilirubin looks scary, but I know that my bilirubin has really always been in the range of 1.1-up to 2. Do they have some sort of correlation,? Should I worry about the Ca 19.9 level? Like I stated earlier I had a contrast enhanced ct scan 4 months ago all normal aside from fatty liver. If i did have gilberts syndrome would.it elevate the ca level? Sorry for so many questions. I am worried about pancreas. Is this something i have to worry about and what should be the bext steo? Thank you



I dont believe it's hemolytic anemia as my ldh waa normal no other tests in this regard performed.
doctor
Answered by Dr. T Chandrakant (2 days later)
Brief Answer:
Most probably Gilbert's

Detailed Answer:
Hi.
Thanks for your query.
Noted the history well and understood the concerns.
Elevated Bilirubin levels with normal other liver functions in a person from USA can be Gilbert's syndrome. You also have normal contrast enhanced CT scan of whole abdomen and that shows liver, gall bladder, bile ducts, pancreas very well.
As you may know 3 to 7% of XXXXXXX population has this mild genetic disorder called Gilbert's syndrome which needs no treatment.
This can be diagnosed by genetic study and get this done if possible to get a confirmed diagnosis so that you can have stress-free life.

As for Ca 19.9 : Raised bilirubin also can can raise this level.
Please get this repeated after some time - say after one month.
CT scan of abdomen being normal, means pancreas too is normal so stop worrying about cancer of pancreas at the moment.
Stress and anxiety are known to enhance bilirubin levels in Gilbert's syndrome hence you need to have really cool and quiet life.

Premature ovarian failure: What is your age now?
Mild fatty liver is very common finding on CT scan and Ultrasound in most of the patients.

I hope this answer helps you to have clear idea.
If all other liver function tests including SGOT, SGPT, Alkaline Phosphatase and GGT, Serum protein levels are normal then not much to worry.

Take care. I hope you are not in Covid-19 area.
Be stress-free.
Give feedback.

Dr T Chandrakant.
Surgical Gastro

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. T Chandrakant (0 minute later)
Brief Answer:
Most probably Gilbert's

Detailed Answer:
Hi.
Thanks for your query.
Noted the history well and understood the concerns.
Elevated Bilirubin levels with normal other liver functions in a person from USA can be Gilbert's syndrome. You also have normal contrast enhanced CT scan of whole abdomen and that shows liver, gall bladder, bile ducts, pancreas very well.
As you may know 3 to 7% of XXXXXXX population has this mild genetic disorder called Gilbert's syndrome which needs no treatment.
This can be diagnosed by genetic study and get this done if possible to get a confirmed diagnosis so that you can have stress-free life.

As for Ca 19.9 : Raised bilirubin also can can raise this level.
Please get this repeated after some time - say after one month.
CT scan of abdomen being normal, means pancreas too is normal so stop worrying about cancer of pancreas at the moment.
Stress and anxiety are known to enhance bilirubin levels in Gilbert's syndrome hence you need to have really cool and quiet life.

Premature ovarian failure: What is your age now?
Mild fatty liver is very common finding on CT scan and Ultrasound in most of the patients.

I hope this answer helps you to have clear idea.
If all other liver function tests including SGOT, SGPT, Alkaline Phosphatase and GGT, Serum protein levels are normal then not much to worry.

Take care. I hope you are not in Covid-19 area.
Be stress-free.
Give feedback.

Dr T Chandrakant.
Surgical Gastro

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. T Chandrakant (13 minutes later)
Hi Dr,

I am currently 38 yrs old. I had ct scan in May and hsd ca 19 level draen in September, do you think I need a new ct scan? I am currently waiting for my XXXXXXX test to come back, but dr put me in for another abd ultrasound and the reading came back normal, but says."pancreatic tail is obscured by bowel gas" so they want to do a MRCP soon. Thank you for clearing my mind Dr. I am so worried about this as I dont know why ca 19 is elevated and my symptoms are kind of gi related too, such as the nausea, heartburn, and inability to eat most of time due to heartburn and nausea. .
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Follow up: Dr. T Chandrakant (0 minute later)
Hi Dr,

I am currently 38 yrs old. I had ct scan in May and hsd ca 19 level draen in September, do you think I need a new ct scan? I am currently waiting for my XXXXXXX test to come back, but dr put me in for another abd ultrasound and the reading came back normal, but says."pancreatic tail is obscured by bowel gas" so they want to do a MRCP soon. Thank you for clearing my mind Dr. I am so worried about this as I dont know why ca 19 is elevated and my symptoms are kind of gi related too, such as the nausea, heartburn, and inability to eat most of time due to heartburn and nausea. .
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Follow up: Dr. T Chandrakant (13 minutes later)
What I am trying to ask is unknown ca 19 level during ct scan in May, but bilirubin at that time during ct scan was 2.2. Ca 19 drawn in September and bilirubin at that time was 1.6 so I am not sure if I should repeat ct scan? I was reading a study where pts with obstructive juandice should never be tested for ca 19 because the bilirubin causes falsely elevated ca 19 levels. It also mentioned how they would divide the bilirubin into the ca 19 number and most pts would have a normal reading. So mine would have been 71÷1.6=44 would still be a little elevated, but primarily normal. I will also do ca 19 level again soon.
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Follow up: Dr. T Chandrakant (0 minute later)
What I am trying to ask is unknown ca 19 level during ct scan in May, but bilirubin at that time during ct scan was 2.2. Ca 19 drawn in September and bilirubin at that time was 1.6 so I am not sure if I should repeat ct scan? I was reading a study where pts with obstructive juandice should never be tested for ca 19 because the bilirubin causes falsely elevated ca 19 levels. It also mentioned how they would divide the bilirubin into the ca 19 number and most pts would have a normal reading. So mine would have been 71÷1.6=44 would still be a little elevated, but primarily normal. I will also do ca 19 level again soon.
doctor
Answered by Dr. T Chandrakant (5 hours later)
Brief Answer:
As detailed

Detailed Answer:
Thanks for your additional information.
Recent normal Ultrasound is a great news and MRCP will confirm the same, I hope.
One of the most common reasons for continued heartburn and nausea is stress and/or anxiety. Please take control of these.
Yes, there are other reasons than cancer for elevated CA 19 and should be searched for and CA 19 alone is not much diagnostic. Needs other evidences too.
Let us see the future reports.
Till then relax.

Dr T C

Above answer was peer-reviewed by : Dr. Prasad
doctor
doctor
Answered by Dr. T Chandrakant (0 minute later)
Brief Answer:
As detailed

Detailed Answer:
Thanks for your additional information.
Recent normal Ultrasound is a great news and MRCP will confirm the same, I hope.
One of the most common reasons for continued heartburn and nausea is stress and/or anxiety. Please take control of these.
Yes, there are other reasons than cancer for elevated CA 19 and should be searched for and CA 19 alone is not much diagnostic. Needs other evidences too.
Let us see the future reports.
Till then relax.

Dr T C

Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. T Chandrakant (5 hours later)
Thank you Dr. I dont know how us is XXXXXXX if they are unable to see pancreatuc tail due to bowel gas most recently. Is this common? Is my ct scan from May sufficient enough to go off of or should I have another scan? Thank you
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Follow up: Dr. T Chandrakant (0 minute later)
Thank you Dr. I dont know how us is XXXXXXX if they are unable to see pancreatuc tail due to bowel gas most recently. Is this common? Is my ct scan from May sufficient enough to go off of or should I have another scan? Thank you
doctor
Answered by Dr. T Chandrakant (3 hours later)
Brief Answer:
MRCP will help the best

Detailed Answer:
Yes, this is not uncommon. Transverse colon and small intestinal loops with gas does not allow ultrasound waves to reach part of pancreas.
Hence they have MRCP (MRI for liver, gallbladder, bile ducts, and pancreas) soon - This will help to resolve the issues further. This is great investigations related to your issues as you have mentioned.
Please go for MRCP asap.


Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
doctor
Answered by Dr. T Chandrakant (0 minute later)
Brief Answer:
MRCP will help the best

Detailed Answer:
Yes, this is not uncommon. Transverse colon and small intestinal loops with gas does not allow ultrasound waves to reach part of pancreas.
Hence they have MRCP (MRI for liver, gallbladder, bile ducts, and pancreas) soon - This will help to resolve the issues further. This is great investigations related to your issues as you have mentioned.
Please go for MRCP asap.


Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. T Chandrakant (1 hour later)
I am very scared for MRCP. . So i still need MRCP even though my ct scan in May was normal dr? Last question sorry
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Follow up: Dr. T Chandrakant (0 minute later)
I am very scared for MRCP. . So i still need MRCP even though my ct scan in May was normal dr? Last question sorry
doctor
Answered by Dr. T Chandrakant (56 minutes later)
Brief Answer:
MRCP is better investigations

Detailed Answer:
You are most welcome to ask question.
MRCP: as mentioned above is MRI of the specific areas concerned with your problems and gives better information than CT scan and Ultrasound in some regards.
Please go for it as your Doctors have planned - in fact insist for it asap.
This will help to clarify further.
Please give feedback .

Take care.
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
doctor
Answered by Dr. T Chandrakant (0 minute later)
Brief Answer:
MRCP is better investigations

Detailed Answer:
You are most welcome to ask question.
MRCP: as mentioned above is MRI of the specific areas concerned with your problems and gives better information than CT scan and Ultrasound in some regards.
Please go for it as your Doctors have planned - in fact insist for it asap.
This will help to clarify further.
Please give feedback .

Take care.
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. T Chandrakant (15 minutes later)
Dr, would it show in my bloodowrk that there is some sort of obstruction? I have all normal labs aside from waxing and waning total bilirubin which has been this way since I am a kid and now the ca 19 at 71. I am praying that the MRCP comes back normal as I am terrified. I don't even know why it was tested to begin with when my us and prior ct scan was unremarkable. The md went off of my symptoms i guess.
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Follow up: Dr. T Chandrakant (0 minute later)
Dr, would it show in my bloodowrk that there is some sort of obstruction? I have all normal labs aside from waxing and waning total bilirubin which has been this way since I am a kid and now the ca 19 at 71. I am praying that the MRCP comes back normal as I am terrified. I don't even know why it was tested to begin with when my us and prior ct scan was unremarkable. The md went off of my symptoms i guess.
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Follow up: Dr. T Chandrakant (4 minutes later)
If everything is normal and ca level either stay the same or decreases when do I have to stop worrying about this ca level?
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Follow up: Dr. T Chandrakant (0 minute later)
If everything is normal and ca level either stay the same or decreases when do I have to stop worrying about this ca level?
doctor
Answered by Dr. T Chandrakant (31 minutes later)
Brief Answer:
As discussed

Detailed Answer:
I can understand your anxiety.
Anxiety as mentioned above is one of the reasons for raised levels in blood work.
First of all, let anxiety be controlled.
Obstruction: is shown by raised levels of Alkaline Phosphatase and GGT - Please see if these are normal or not.
CT scan and Ultrasound are normal.
Let us wait for MRCP report.
As mentioned above - CA 19 alone raised has to be substantiated by other relevant reports.
You have mentioned that your Doctor has done all tumour markers since your bilirubin is raised.
Repeat CA levels may be reduced or near normal - so let us get this repeated.
To come to a conclusion your Doctors would consider all the things - symptoms, signs, investigations in-toto and then only come to a conclusion.

Stop worrying at the moment.

Dr T C



Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
doctor
Answered by Dr. T Chandrakant (0 minute later)
Brief Answer:
As discussed

Detailed Answer:
I can understand your anxiety.
Anxiety as mentioned above is one of the reasons for raised levels in blood work.
First of all, let anxiety be controlled.
Obstruction: is shown by raised levels of Alkaline Phosphatase and GGT - Please see if these are normal or not.
CT scan and Ultrasound are normal.
Let us wait for MRCP report.
As mentioned above - CA 19 alone raised has to be substantiated by other relevant reports.
You have mentioned that your Doctor has done all tumour markers since your bilirubin is raised.
Repeat CA levels may be reduced or near normal - so let us get this repeated.
To come to a conclusion your Doctors would consider all the things - symptoms, signs, investigations in-toto and then only come to a conclusion.

Stop worrying at the moment.

Dr T C



Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. T Chandrakant (21 minutes later)
Yes Dr. I will upload what I have so you can see. Thank you
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Follow up: Dr. T Chandrakant (0 minute later)
Yes Dr. I will upload what I have so you can see. Thank you
doctor
Answered by Dr. T Chandrakant (2 minutes later)
Brief Answer:
Most welcome

Detailed Answer:
Sure.
And most welcome.

Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
doctor
Answered by Dr. T Chandrakant (0 minute later)
Brief Answer:
Most welcome

Detailed Answer:
Sure.
And most welcome.

Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. T Chandrakant (23 minutes later)
I also sent my lab from XXXXXXX 02 that my bilirubin was 1.3 and it has been trending like this for as long as i can remember this was when i was 19.
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Follow up: Dr. T Chandrakant (0 minute later)
I also sent my lab from XXXXXXX 02 that my bilirubin was 1.3 and it has been trending like this for as long as i can remember this was when i was 19.
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Follow up: Dr. T Chandrakant (3 hours later)
Hi Dr, have you looked over labs?

I am wondering why I shoulr get the MRCP asap dr?
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Follow up: Dr. T Chandrakant (0 minute later)
Hi Dr, have you looked over labs?

I am wondering why I shoulr get the MRCP asap dr?
doctor
Answered by Dr. T Chandrakant (2 hours later)
Brief Answer:
To rule out cancer of pancreas

Detailed Answer:
Thanks for the reports. Noted.
MRCP will help to rule out pancreatic cancer.

Dr T C
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
doctor
Answered by Dr. T Chandrakant (0 minute later)
Brief Answer:
To rule out cancer of pancreas

Detailed Answer:
Thanks for the reports. Noted.
MRCP will help to rule out pancreatic cancer.

Dr T C
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. T Chandrakant (25 minutes later)
Dr, i thought the ct scan and us were already used in ruling out pancreatic cancer?
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Follow up: Dr. T Chandrakant (0 minute later)
Dr, i thought the ct scan and us were already used in ruling out pancreatic cancer?
doctor
Answered by Dr. T Chandrakant (6 hours later)
Brief Answer:
As discussed

Detailed Answer:
I can understand.
You have mentioned in your feedback: ( I am currently waiting for my XXXXXXX test to come back, but dr put me in for another abd ultrasound and the reading came back normal, but says."pancreatic tail is obscured by bowel gas" so they want to do a MRCP soon.)
I think your Doctors just want to confirm and do not want to miss the diagnosis.

I hope this clarifies your doubts further.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. T Chandrakant (0 minute later)
Brief Answer:
As discussed

Detailed Answer:
I can understand.
You have mentioned in your feedback: ( I am currently waiting for my XXXXXXX test to come back, but dr put me in for another abd ultrasound and the reading came back normal, but says."pancreatic tail is obscured by bowel gas" so they want to do a MRCP soon.)
I think your Doctors just want to confirm and do not want to miss the diagnosis.

I hope this clarifies your doubts further.
Note: For further queries related to kidney problems Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
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Dr. T Chandrakant

General Surgeon

Practicing since :1984

Answered : 19777 Questions

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Hi Dr I Have Had What I Think To Be

Hi Dr I have had what I think to be gilberts syndrome, but never confirmed. As long as I can remember my levels have always waxed and waned highest being 2.2 amd asymptomatic in that aspect. Just recently I went to the hospital due to severe dyspepsia and bilirubin at that time was 2.2. I had upper egd and confirmed chronic esophagitis and antral erythema. Fast forward andi had asked my dr to follow up with hyperbilirubemia amd although ditect and indirect normal the unconjucated being on the higher end of normal at 0.74, hgb and liver function normal. Had ct scan of abd and pelvis with contrast in May 2020 and all unremarkable aside from 13 cm and mild fatty infiltrate liver. Would you consider this gilberts syndrome or is the bilirubin posaibly due to fatty liver? Next thing is I also have a hx of premature ovarian failure and was going to be placed on Hrt, but due to coagulapathy issues on dad side of family I was sent to a hematologist/oncologist. She asked about my symptoms and i mentioned heartburn and nausea due to assumibg chronic esophagitis so over the yr I lost 6 lbs not drastic weight loss, but she ran some tests and tumor markers and all negative except for ca 19.9 which was 71 and I am beside myself nervous and scared. This along with the bilirubin looks scary, but I know that my bilirubin has really always been in the range of 1.1-up to 2. Do they have some sort of correlation,? Should I worry about the Ca 19.9 level? Like I stated earlier I had a contrast enhanced ct scan 4 months ago all normal aside from fatty liver. If i did have gilberts syndrome would.it elevate the ca level? Sorry for so many questions. I am worried about pancreas. Is this something i have to worry about and what should be the bext steo? Thank you I dont believe it's hemolytic anemia as my ldh waa normal no other tests in this regard performed.