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,
What is causing jaundice of sclera and itching on the skin that started about six weeks ago? My gall bladder has been removed, and the common bile duct is dilated to 8.4 mm. The MRI scan was unremarkable, as well as the ultrasound. I also have hereditary spherocytosis. Currently, I am taking Protonix and Ibuprofen. I have undertaken the following laboratory investigations, and the values are:
1) Triglycerides level - 253 mg/dL.
2) Cholesterol level - 279 mg/dL.
3) LDL Cholesterol - 190 mg/dL.
4) Total bilirubin - 5.3 mg/dL.
5) Direct bilirubin - 3.6 mg/dL.
6) Aspartate aminotransferase (AST/SGOT) - 157 IU/L.
7) Alanine aminotransferase (ALT/SGPT) - 260 IU/L.
8) Alkaline phosphatase - 197 IU/L.
Hello,
Welcome to icliniq.com.
It appears that hereditary spherocytosis is responsible for the problem. It results in an increased breakdown of RBC or red blood cells, which results in hemolytic anemia. Jaundice is due to hereditary spherocytosis, and jaundice is causing itching.
Patient's Query
Hello doctor,
I have been pushing our primary care provider to check for this to be the problem. They have done an ultrasound, CT, and MRI that shows an enlarged spleen. All tests were otherwise normal. We are going to see a GI specialist soon. My father had a similar event years ago, and his spleen was removed. They want to do an ERCP next. I am not so sure about having it done.
Hello,
Welcome back to icliniq.com.
A surgical gastroenterologist is the right doctor to treat the problem. As you rightly said, splenectomy appears to be the treatment. They are doing ERCP (endoscopic retrograde cholangiopancreatography) to investigate the problem thoroughly before the final decision.
Patient's Query
Hello doctor,
Are you able to explain the sudden increase in the lipid panel? Cholesterol was 130 mg/dL in April last year, and all the other parameters were normal. What causes the liver enzymes and bilirubin levels to increase with spherocytosis?
Hello,
Welcome back to icliniq.com.
Understand that the liver plays a key role in the degradation of cholesterol and its elimination through bile. Any liver pathology can adversely affect the metabolism and elimination of cholesterol, resulting in hypercholesterolemia. Also, due to some unexplainable reason, cholesterol synthesis by the liver increases during jaundice. Please note that lipid-lowering medications may not be useful. Enzyme elevations are due to cholangitis seen in hyperbilirubinemia.
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General Practitioner
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