A-18-year-old woman presented with 1-week of history of fever and malaise. She had mild jaundice and elevated temperature. Hemoglobin was 13.8 g/dL, leukocyte count 13 x 10⁹/L. Serum bilirubin was elevated (42 mmol/L) and contained 95% unconjugated bilirubin. Liver enzyme tests were normal. Which of the following is the most likely cause of these signs and symptoms?

Question

Quizplus · Accepted Answer

The Answer is B
EXPLANATION: Glucuronyl transferase is the enzyme that conjugates bilirubin in the liver, after which it is excreted in bile or urine. A hereditary defect in glucuronyl transferase concentration, or activity, is called Gilbert syndrome. It may lead to mild jaundice and general discomfort with typical onset in childhood or early adulthood. Alcohol poisoning leads to liver damage, and an elevation of conjugated bilirubin. Abnormalities of liver enzyme tests would be expected. Lactate dehydrogenase catalyzes the conversion of lactate to pyruvate as part of cellular energy production. Since many cells including red blood cells are rich in LDH, increased serum LDH levels could point toward excessive hemolysis, but would not be a cause for it. Although hemolysis that exceeds the capacity of the liver to clear bilirubin from serum would lead to increased unconjugated bilirubin, it is not the best choice due to the woman's normal hemoglobin (12-16 g/ dL for females). Obstruction of bile flow leads to backup of largely conjugated bilirubin in the blood stream.

A-18-Year-Old Woman Presented with 1-Week of History of Fever and Malaise