Q: I had symptoms of jaundice (fever, abdominal pain, yellow eyes, yellow urine). My doctor suggested it is a case of Infective hepatitis. I went for complete bed rest of more than one month (29th november 2001 to 6th jan 2002). Currently I feel ok except some pain on right side below ribcage (where lever is located). I am still following strict diet control (No oily food, no out side food, boiled water and glucon-D). My job does not require high physical stress (I am s/w professional). But as you can see the bilirubin count has to yet come down to normal level.1) Why the count has not come down to normal levels?2) What is the significance of direct and indirect bilirubin? As you can see, direct bilirubin has decreased over the period however the indirect bilirubin has increased. What does it indicate?3) What are the chances of relapse?4) What should be the next course of action?

A:The physician should have told you that hepatitis A antibodies were positive (IgM antibody is important for definitive diagnosis). Fever is compatible with A hepatitis but not pain. It is usually painless. Biliary tract disease often mimics acute hepatitis, and in his case biliary tract disease (such as stone incarceration) should be ruled out before settling with the Dx of acute hepatitis A.In the acute phase of hepatitis or obstructive jaundice, direct bilirubinoverwhelms indirect bilirubin, and the relationship between direct andindirect bilirubin in his case can be explained, but the decline ofbilirubin levels is slower than one would expect with accute hepatitis A. Inshort, he needs hepatitits A serology and careful imaging evaluation of the biliary tract.