elevated biliruben

Editorial Team / Admin · Oct 20, 2005

Hi all - I'm hoping some of you lab experts out there can maybe give me some insight on my own lab values since I feel like my own health care group doesn't seem to be taking things too seriously.
I had a routine annual physical and labs done a few weeks ago and all was well except the total bilirubin which was 2.0. I got called back in for a follow up for it and they had me go for the differential values (I think thats what it is??) At any rate the direct was 0.4 and indirect was 2.0 making the total even slightly higher than it had been about a couple weeks earlier.
Liver enzymes and everything else are WNL. Does anybody have any ideas on this?? The nurse practitioner just keeps saying "I hate bilirubin" and I'm hearing the doc that she must have asked about it in the background saying the same thing. I had to call 3 times before anybody would call me back on it and I feel like a serious problem is going to get ignored because everybody "hates bilirubin" and doesn't want to be bothered to figure it out.

Hello, Spider Cat,:balloons:

In my experience with this type of elevation and in the abscence of any other elevated liver enzyme, the dx has almost always been gallbladder dz....

Trauma Columnist · Oct 20, 2005

So sorry for this confusion for you Spider Cat. Might I suggest that since we can't provide medical advice, that you seek a second opinion? That would give you the information you seek. Bilirubin can be elevated for various reasons and for no reason at all. Please seek another opinion. Good luck.

papawjohn · Oct 21, 2005

Hey Spider

I sympathize with the nurse practitioner. Not because BILIRUBIN is complex itself but because it raises so many questions it doesn't answer. Here's the bilirubin story: Your RBCs are very short lived. Maybe they last longer than the average hollywood marriage, but not much. They last about 90 to 120 days and then spill their contents into the blood stream.

This is a problem because one of their contents is iron and iron is a corrosive (chemically active) substance. (Iron is why your Pt with intra-peritoneal hemorrhage or a big hematoma has fever and pain. It's essentially having a chemical reaction with his tissues!! Ouch!!) So your body has to get this iron out of the blood stream and into some sort of substance that's easier to handle, then flush it out of you. OK?

The INDIRECT BILI is the iron-substance that's been dumped into the blood by the dissolving RBCs. Your liver is going to wrap it up into a less-corrosive form (obviously--DIRECT BILI) which you will pass and flush. (Bilirubin gives stool its color.)

So BILIRUBIN as a lab involves the liver (you have cirrhosis? Hepatitis?). The whole Gallbladder and Biliary track (Fat intolerance? Are you the typical Cholecystectomy Pt--Fair, Fat, Female and under Forty?) Or the blood stream (recent anemia? bruise easily?)

See--now you understand Bilirubin and you haven't learned that much about your health. Isn't medicine fun?

Papaw John

Editorial Team / Admin · Oct 21, 2005

Spider Cat,

As traumaRUs said, you really need to seek a second opinion. And, please do not ignore it or just forget about it, o.k.? May not be anything to worry about, but, you need to get the second opinion.