Q: I am a 41 years old man who has recently developed a tendency of vomiting. I also get tired soon because of my hectic work, as I have to travel a lot. The timing of taking food is not fixed and I don’t get sound sleep either. I have undergone various tests 2 months back and the results were: glucose (fasting) – 89 mg/dl, urea - 22, creatinine - 0.9 mg/dl, haemoglobin – 13.8, TLC – 6200. DLC: neutrophils – 52, lymphocytes – 46, monocytes – 1, eosinophils – 1, ESR – 3. Liver profile - total protein - 7.3, albumin - 4.8, globulin - 2.5, total bilirubin - 1.6, bilirubin direct - 0.4, bilirubin indirect - 1.2, SGOT/AST – 38, SGPT/ALT – 41, alkaline phosphatase – 84, GGTP - 43. Urine analysis - colour - pale yellow, sediment – nil, specific gravity - 1.015. Chemical examination - ph - 6.5, urine sugar fasting – nil, albumin (urine) – nil, bile salt negative – negative, bile pigment - negative. My bilirubin total test was done 2 years back and was 1.5, which was 2.2, eight years back. Why is my bilirubin always higher than the normal range?

A:A mildly raised indirect bilirubin level in the presence of normal liver function tests, such as you have, can be a familial condition (autosomal dominant) called Gilbert's syndrome. The bilirubin level rises during any intercurrent illness but it does not give any symptoms and has an excellent prognosis. The diagnosis can be established by demonstrating a two-fold rise in indirect bilirubin level after a prolonged fast or an appropriate chemical challenge (nicotinic acid). This can be confirmed by a competent physician whose advice you should seek to take it further.