[khanar]

A 19-year-old male presents to the student health service after his roommate noted a yellowish discoloration to his skin while up late studying for an exam. After a meal and several hours sleep, the discoloration resolved. Laboratory tests are obtained, ALT 25 U/dL, AST 20 U/dL, Bilirubin (direct) 0.8 mg/dL, Bilirubin (total) 2.5 mg/dL. Which of the following is responsible for this patient’s disease?

A- Canalicular cholestasis
B- Decreased activity of glucuronyl transferase
C- Impaired transport of bilirubin into the bile canaliculus
D- Impaired uptake of circulating bilirubin
E- Immune hemolysis

 

[just_md]

A.

Just guess. More rational.

 

[ath.pantelis]

This is typical presentation of Gilbert's syndrome (very impressive name, though harmless!), aka glycuronyl-transferase deficiency/insufficiency. The scenario describes a teenager/young adult with manifestation of jaundice after stress and low food intake. There are no pathophysiologic sequelae for this entity and the prognosis is excellent.

Binding of indirect bilirubin to glycuronic acid is the first step of rendering bilirubin water soluble (i.e. direct) and thus excretable (through the GI tract and the urine). Consequently, these patients manifest INdirect hyperbilirubinemia.

 

[just_md]

Thanks

This is typical presentation of Gilbert's syndrome (very impressive name, though harmless!), aka glycuronyl-transferase deficiency/insufficiency. The scenario describes a teenager/young adult with manifestation of jaundice after stress and low food intake. There are no pathophysiologic sequelae for this entity and the prognosis is excellent.

Binding of indirect bilirubin to glycuronic acid is the first step of rendering bilirubin water soluble (i.e. direct) and thus excretable (through the GI tract and the urine). Consequently, these patients manifest INdirect hyperbilirubinemia.

You are right. It's Gilbert's syndrome.
Mild jaundice (harmless) may appear under conditions of exertion, stress, fasting, and infections.

 

[Doctor Ali]

A 19-year-old male presents to the student health service after his roommate noted a yellowish discoloration to his skin while up late studying for an exam. After a meal and several hours sleep, the discoloration resolved. Laboratory tests are obtained, ALT 25 U/dL, AST 20 U/dL, Bilirubin (direct) 0.8 mg/dL, Bilirubin (total) 2.5 mg/dL. Which of the following is responsible for this patient's disease?

A- Canalicular cholestasis
B- Decreased activity of glucuronyl transferase
C- Impaired transport of bilirubin into the bile canaliculus
D- Impaired uptake of circulating bilirubin
E- Immune hemolysis

This is Gilbert's syndrome. This has both problems in which Answer choices are B and D. I will shoot for D. Which one do you go for?

 

[nsesereso]

This is Gilbert's syndrome. This has both problems in which Answer choices are B and D. I will shoot for D. Which one do you go for?

Dr. Ali u are right that this is Gilbert syndrome and both A and D are right but what will I choose?
I will choose A. My reasons are not conviencing though.