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Causes Of High Bilirubin In Adults

 
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MessagePosté le: Ven 8 Juil - 15:50 (2016)    Sujet du message: Causes Of High Bilirubin In Adults Répondre en citant




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Longo,,,DL,,,,et,,,al.,,,,eds.,,,In,,,,rare,,,,cases,,,,,blood,,,,transfusions,,,,may,,,,be,,,,needed.,,,,Diseases,,,that,,,increase,,,the,,,rate,,,of,,,bilirubin,,,formation,,,(eg,,,,hemolysis,,,,dyserythropoiesis),,,,reduce,,,hepatic,,,uptake,,,of,,,bilirubin,,,(eg,,,,medications,,,[gemfibrozil,,,,irinotecan,,,and,,,the,,,protease,,,inhibitors,,,,atazanavir,,,,and,,,indinavir];,,,portosystemic,,,shunts),,,,or,,,reduce,,,the,,,rate,,,of,,,bilirubin,,,conjugation,,,(eg,,,,Gilbert,,,syndrome),,,result,,,in,,,increased,,,levels,,,of,,,indirect,,,bilirubin,,,(Figure).FigureSuggested,,,Diagnostic,,,Approach,,,to,,,Hyperbilirubinemia,,,Based,,,on,,,Clinical,,,ExperienceGilbert,,,syndrome,,,,also,,,known,,,as,,,Gilbert-Meulengracht,,,syndrome,,,,is,,,a,,,hereditary,,,condition,,,with,,,incomplete,,,penetrance,,,,characterized,,,by,,,intermittent,,,unconjugated,,,hyperbilirubinemia,,,in,,,the,,,absence,,,of,,,hepatocellular,,,disease,,,or,,,hemolysis.1,,,Gilbert,,,syndrome,,,is,,,present,,,in,,,5%,,,to,,,10%,,,of,,,Western,,,European,,,populations,,,and,,,patients,,,are,,,frequently,,,unaware,,,of,,,their,,,diagnosis.2,3,,,A,,,genetic,,,variant,,,in,,,the,,,promoter,,,region,,,of,,,the,,,UGT1A1,,,gene,,,,which,,,encodes,,,for,,,UDP-GT,,,,is,,,associated,,,with,,,Gilbert,,,syndrome,,,and,,,there,,,is,,,an,,,additional,,,thymine-adenine,,,(TA),,,base,,,pair,,,in,,,the,,,TATA,,,box,,,instead,,,of,,,the,,,normal,,,6,,,pairs.2,,,In,,,Gilbert,,,syndrome,,,,there,,,is,,,a,,,70%,,,reduction,,,in,,,the,,,liver’s,,,ability,,,to,,,conjugate,,,bilirubin,,,that,,,can,,,lead,,,to,,,intermittent,,,episodes,,,of,,,nonpruritic,,,jaundice,,,,which,,,are,,,precipitated,,,by,,,fasting,,,,infection,,,,and,,,overexertion.3,,,Several,,,therapeutic,,,drugs,,,including,,,gemfibrozil,,,,irinotecan,,,,atazanavir,,,,and,,,indinavir,,,inhibit,,,UDP-GT,,,activity,,,and,,,can,,,trigger,,,jaundice,,,episodes,,,in,,,Gilbert,,,syndrome.4The,,,diagnosis,,,of,,,Gilbert,,,syndrome,,,as,,,the,,,cause,,,of,,,hyperbilirubinemia,,,should,,,only,,,be,,,made,,,after,,,excluding,,,other,,,liver,,,and,,,hematologic,,,disorders.,,,Sweat,,Test.,,Protein,,,Electrophoresis.,,,..,,In,,,Gilbert,,,syndrome,,,,the,,,degree,,,of,,,hyperbilirubinemia,,,is,,,typically,,,less,,,than,,,5,,,mg/dL,,,and,,,the,,,conjugated,,,bilirubin,,,is,,,typically,,,less,,,than,,,20%,,,of,,,the,,,total,,,bilirubin,,,fraction.3,,,The,,,Medicare,,,midpoint,,,reimbursement,,,for,,,a,,,total,,,and,,,direct,,,serum,,,bilirubin,,,is,,,$9.25,,,for,,,each.5,,,The,,,cost,,,of,,,UGT1A1,,,gene,,,analysis,,,ranges,,,from,,,$75,,,to,,,$103,,,,although,,,it,,,is,,,rarely,,,used,,,for,,,diagnosis.6.,,,WBC,,,,Differential.,,,,..,,,

Gastrin.,,,This,,,may,,,occur,,,if,,,gallstones,,,,tumors,,,of,,,the,,,pancreas,,,,or,,,other,,,conditions,,,are,,,present.,,,Direct,,,LDL-C.,,,Department,,of,,Health,,and,,Human,,Services,,National,,Institutes,,of,,Health,,Page,,last,,updated:,,07,,June,,2016,,.,,Rubella.,,,,Pleural,,Fluid,,Analysis.,,Hello,,,,,!,,,,UPGRADE,,,,TO,,,,GOLD,,,,for,,,,additional,,,,benefits,,,,PROFILE,,,,TRACK,,,,EXERCISE,,,,PROGRESS,,,,COMMUNITY,,,,INBOX,,,,SETTINGS,,,,LOG,,,,OUT,,,,SIGN,,,,UP,,,,LOG,,,,IN,,,,Log,,,,In,,,,Keep,,,,me,,,,logged,,,,in,,,,Forgot,,,,your,,,,password?,,,,0,,,,Notifications,,,,Notifications,,,,User,,,,Preferences,,,,You're,,,,all,,,,caught,,,,up!,,,,,,,,,,,,,,,,,,,,Official,,,,Partner,,,,of,,,,the,,,,LIVESTRONG,,,,Foundation,,,,FOOD,,,,FITNESS,,,,HEALTH,,,,TRACKER,,,,MORE,,,,WORKOUTS,,,,WEIGHT,,,,MANAGEMENT,,,,RECIPES,,,,DISEASES,,,,&,,,,CONDITIONS,,,,LIFESTYLE,,,,FASHION,,,,&,,,,BEAUTY,,,,PARENTING,,,,RELATIONSHIPS,,,,&,,,,FAMILY,,,,.,,,,Departments,,,&,,,CentersDoctors,,,&,,,Medical,,,StaffMedical,,,Departments,,,&,,,CentersResearch,,,Centers,,,&,,,ProgramsAbout,,,Mayo,,,ClinicContact,,,UsMeet,,,the,,,StaffFind,,,a,,,directory,,,of,,,doctors,,,and,,,departments,,,at,,,all,,,Mayo,,,Clinic,,,campuses.,,,[PubMed]5.,,,Philadelphia,,,,PA:,,,Elsevier;,,,2012:chap,,,29.Pratt,,,DS.,,,

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