Dr. J. N. Naidu
General Practitioner
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
A year ago, I had an ultrasound scan done. I have attached the images. The reports showed elevated bilirubin levels, but they never explained my ultrasound reports to me. However, I saw a GI and had endless bloodwork done to rule out any liver diseases like Wilson's disease, hemochromatosis, autoimmune disorders, etc. The GI said the ultrasound was from drinking too much alcohol at once. Everything came back to normal. They diagnosed me with Gilbert's syndrome. A year later, I got my routine lab tests done, and my ALT is elevated at 54 U/L. I have attached the lab reports. I have no symptoms presently. I did get sick with a viral illness four days after the lab that showed elevated ALT. I mostly eat healthy food, and I have a BMI of 20.3. I do not exercise. Is something wrong with my liver that they are missing? My mother has NASH. I stopped drinking alcohol almost a year ago, but I smoke. I am not under any medication currently. What could be going on now? What did that ultrasound a year ago mean?
Hi,
Welcome to icliniq.com.
I read your query and understand your concern.
I understand your anxiety. Please understand that Gilbert's syndrome is a relatively benign condition. It is usually diagnosed accidentally when routine blood tests are performed. It occurs due to the mutation of a biochemical enzyme-producing gene responsible for converting unconjugated bilirubin to conjugated bilirubin and, ultimately, excretion of the bilirubin. Because of enzyme defects, bilirubin excretion is slow in people affected by Gilbert's syndrome. In addition, stress tends to elevate the bilirubin levels.
I suggest you take the following precautions-
1. You must always inform your doctor about Gilbert's syndrome before any medication is prescribed to you.
2. You must eat a healthy diet.
3. You must avoid skipping meals or fasting.
4. You must get the ALT test done yearly as a precautionary measure. Mild ALT (alanine transaminase enzyme) elevation is likely due to your alcohol intake earlier. You should not be worried about this mild ALT increase.
5. You must avoid using any medications, even Acetaminophen, unless necessary.
Please feel free to contact us for further assistance.
Patient's Query
Thank you,
What do you think the ultrasound a year ago that I uploaded meant? Was that really from alcohol? Do you think that abnormal ALT values now are from alcohol? I have not had a drink in almost an entire year. My doctor is retesting my ALT in three months. Do you think it will go back down if I stop stressing, eat healthy, and exercise?
Hi,
Welcome back to icliniq.com.
I understand your concern.
Since you have Gilbert's syndrome, reducing stress on the liver is essential. Alcohol is hepatotoxic, and it causes elevation of ALT (alanine transaminase enzyme). Therefore, I would suggest that the mild elevation of ALT is due to alcohol. If there is no further elevation of ALT (even if there is no decrease) after a year, we can presume that the cause of elevation was alcohol.
I will again emphasize and suggest that you must avoid taking medications or alcohol so that there is no stress on the liver.
I believe that ALT values will not increase further if you eat a healthy diet, have less stress, and perform regular mild exercise. The ALT values usually take a long time to decrease or return to normal. Therefore, if ALT does not increase further in your upcoming tests, it is a positive sign.
Thank you.
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General Practitioner
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