How do I manage high bilirubin, side ache, and fatigue?

Hello,

Welcome to icliniq.com.

I am reviewing your case history and attached files (attachment removed to protect the patient's identity) and will get back to you in a while.

Kindly wait for my detailed response.

Thank you.

Hello,

Welcome back to icliniq.com.

I have read your query and understand your concern.

I suggest you do the blood investigations, including:

1. Complete blood profile with peripheral blood smear examination to look for red blood cell breakdown, reticulocyte count, LDH (lactate dehydrogenase) levels, and Coombs test (direct and indirect).
2. Repeat LFTs (liver function tests) with very good hydration status.

The above simple reports would give us a good idea about your raised bilirubin levels. You can get these tests done or ask your doctor to write them up for you if any difficulty. Whenever total bilirubin goes above 2.5 units, there would be some yellow discoloration of the sclera; your level is 2.6 on current liver function tests, explaining this.

Regarding the mild side ache on the right side, current LFTs do not explain your right upper abdominal pain(site of liver and gallbladder) because on CT scan liver, gallbladder, biliary channels, and even pancreas and spleen were normal looking, the simple hepatic cyst was an incidental finding, it is asymptomatic and not explaining the current pattern of the liver test.

Low energy can be explained by the above pattern. You may feel lethargic if there is dehydration, if there is any peripheral breakdown of red blood cells, or in the resolving phase of some liver inflammatory process like minor hepatitis. Although a rare genetic disorder like Gilbert syndrome is usually asymptomatic.

Do you have any old liver function test reports with you, like a few weeks, a couple of months, or even years back? Just for reference, with the current liver function tests. Is there any recent change in your medicine, like the introduction of a new medicine, or taking any herbal medicines, or anything?

Is there any family history of issues like isolated, raised indirect bilirubin levels in your parents or siblings, or any blood disorders or need for blood transfusions?

I hope this helps.

Thank you.

Hello,

Welcome back to icliniq.com.

I have reviewed the attached report (attachment removed to protect the patient's identity). This complete blood profile was normal, including your hemoglobin, red blood cell levels, and your platelets. White cell counts were mildly raised but likely due to some minor infection at that time. Otherwise, it is a normal complete blood profile.

I hope this helps.

Thankyou.

Hello,

Welcome back to icliniq.com.

There is no significant liver risk associated with Semaglutide. Sometimes, it causes weakness and lethargy, and rarely, some red blood cell breakdown, which can cause raised indirect bilirubin levels. Still, I suggest going for repeat liver function tests at least with a good hydration status, before moving forward. There is a good possibility for improvement in the LFTs because the liver has the best natural healing potential; it does not need medicine or treatment in most cases, one just has to take a good, healthy diet and avoid unnecessary medicine.

I hope this helps.

Thank you.