Q: Four years back I suffered mild hepatomegaly with a bilirubin at 1.4 mg/cumm and the ultrasound showed liver enlargement. I had taken the drug Hepamerz. Now again I am suffering from mild hepatomegaly. The bilirubin is mildly increased to 1.4 only. HBsAg test is negative. Why does it happen so frequently and will it affect the liver? What tests are required? What precautions should be taken and do I need vaccination to avoid Hepatitis?

A:Mild hepatomegaly that you have mentioned is a subjective assessment which in your case is based on ultrasound. I would be interested to know other liver characteristics on your ultrasound such as liver echogenicity, surface regularity, any evidence of fatty liver, etc? In the absence of other pathology, it is unlikely to be of any major consequence. Your bilirubin is mildly raised to 1.4 mg%. What is the direct and indirect fraction? It is not uncommon in some individuals to have an enzymatic defect (called Gilberts syndrome), wherein the bilirubin is slightly raised which is mainly the unconjugated fraction. This has no clinical consequence and is not associated with any disease in the later life. Of course, it is important to investigate for any other disorder before we label this diagnosis, and you should consult a Gastroenterologist/Hepatologist for the same. Medicines like Hepamerz has no role in your case. Besides Hepatitis B, you should also get yourself checked for Hepatitis C.