GALLSTONE DISEASE WITH UNCONJUGATED HYPERBILIRUBINEMIA: CLINICAL APPROACH TO GILBERT’S SYNDROME
Gallstones are the commonest ailment affecting the hepato-biliary system. Associated jaundice is usually direct, commonly due to biliary obstructive lesions. Unconjugated hyperbilirubinemia with cholelithiasis is commonly seen with hemolytic disease. In the absence of hemolysis or systemic causes, c...
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| Format: | Article |
| Language: | English |
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Editura Universitara Carol Davila
2019-07-01
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| Series: | Journal of Surgical Sciences |
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| Online Access: | http://journalofsurgicalsciences.com/index.php/jss/article/view/260 |
| _version_ | 1818975617319698432 |
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| author | Suneed Kumar Sneha Jha Anshuman Pandey Shibumon M Madhavan Dinesh Kumar Smita Chauhan Shakeel Masood |
| author_facet | Suneed Kumar Sneha Jha Anshuman Pandey Shibumon M Madhavan Dinesh Kumar Smita Chauhan Shakeel Masood |
| author_sort | Suneed Kumar |
| collection | DOAJ |
| description | Gallstones are the commonest ailment affecting the hepato-biliary system. Associated jaundice is usually direct, commonly due to biliary obstructive lesions. Unconjugated hyperbilirubinemia with cholelithiasis is commonly seen with hemolytic disease. In the absence of hemolysis or systemic causes, congenital causes prevail, commonest of which is Gilbert’ Syndrome. This study aims to ascertain a clinical approach to the patient of gallstones with Gilbert’s syndrome. This is retrospective study of 58 patients with gallstone associated unconjugated hyperbilirubinemia, who underwent surgery over a two-year period. Patients underwent repeat blood investigations and ultrasound to confirm the diagnosis. Obstructive biliary pathology was ruled out by MRCP images; EUS added if indicated. The remaining patients underwent genetic test for Gilbert’s syndrome – namely UGT1A1 gene assessment by PCR. All patients underwent laparoscopic cholecystectomy as routine; with addition of intra-operative liver biopsy. Sixteen of the 58 patients were short-listed to be high risk factors for harboring Gilbert’s syndrome after ruling out other systemic causes. On gene study, 14 patients tested positive for UGT1A1 gene, hence Gilbert’s syndrome. The other two were kept on follow up for jaundice recurrence in future. The management algorithm is depicted as flowchart. Gilbert’s syndrome can be identified in select “high-risk” individuals presenting with gallstone disease. Genetic testing is gold standard, and helps in effective management and better patient counselling. |
| first_indexed | 2024-12-20T15:58:48Z |
| format | Article |
| id | doaj.art-5b7e423b56574d3e8da19bd9ab1ced4d |
| institution | Directory Open Access Journal |
| issn | 2360-3038 2457-5364 |
| language | English |
| last_indexed | 2024-12-20T15:58:48Z |
| publishDate | 2019-07-01 |
| publisher | Editura Universitara Carol Davila |
| record_format | Article |
| series | Journal of Surgical Sciences |
| spelling | doaj.art-5b7e423b56574d3e8da19bd9ab1ced4d2022-12-21T19:34:22ZengEditura Universitara Carol DavilaJournal of Surgical Sciences2360-30382457-53642019-07-016210.33695/jss.v6i2.260260GALLSTONE DISEASE WITH UNCONJUGATED HYPERBILIRUBINEMIA: CLINICAL APPROACH TO GILBERT’S SYNDROMESuneed Kumar0Sneha Jha1Anshuman Pandey2Shibumon M Madhavan3Dinesh Kumar4Smita Chauhan5Shakeel Masood6Dr. Ram Manohar Lohia Institute of Medical SciencesDr. Ram Manohar Lohia Institute of Medical SciencesDr. Ram Manohar Lohia Institute of Medical SciencesDr. Ram Manohar Lohia Institute of Medical SciencesDr. Ram Manohar Lohia Institute of Medical SciencesDr. Ram Manohar Lohia Institute of Medical SciencesDr. Ram Manohar Lohia Institute of Medical SciencesGallstones are the commonest ailment affecting the hepato-biliary system. Associated jaundice is usually direct, commonly due to biliary obstructive lesions. Unconjugated hyperbilirubinemia with cholelithiasis is commonly seen with hemolytic disease. In the absence of hemolysis or systemic causes, congenital causes prevail, commonest of which is Gilbert’ Syndrome. This study aims to ascertain a clinical approach to the patient of gallstones with Gilbert’s syndrome. This is retrospective study of 58 patients with gallstone associated unconjugated hyperbilirubinemia, who underwent surgery over a two-year period. Patients underwent repeat blood investigations and ultrasound to confirm the diagnosis. Obstructive biliary pathology was ruled out by MRCP images; EUS added if indicated. The remaining patients underwent genetic test for Gilbert’s syndrome – namely UGT1A1 gene assessment by PCR. All patients underwent laparoscopic cholecystectomy as routine; with addition of intra-operative liver biopsy. Sixteen of the 58 patients were short-listed to be high risk factors for harboring Gilbert’s syndrome after ruling out other systemic causes. On gene study, 14 patients tested positive for UGT1A1 gene, hence Gilbert’s syndrome. The other two were kept on follow up for jaundice recurrence in future. The management algorithm is depicted as flowchart. Gilbert’s syndrome can be identified in select “high-risk” individuals presenting with gallstone disease. Genetic testing is gold standard, and helps in effective management and better patient counselling.http://journalofsurgicalsciences.com/index.php/jss/article/view/260CholelithiasisIndirectCongenital HyperbilirubinemiaCholecystectomyJaundice |
| spellingShingle | Suneed Kumar Sneha Jha Anshuman Pandey Shibumon M Madhavan Dinesh Kumar Smita Chauhan Shakeel Masood GALLSTONE DISEASE WITH UNCONJUGATED HYPERBILIRUBINEMIA: CLINICAL APPROACH TO GILBERT’S SYNDROME Journal of Surgical Sciences Cholelithiasis Indirect Congenital Hyperbilirubinemia Cholecystectomy Jaundice |
| title | GALLSTONE DISEASE WITH UNCONJUGATED HYPERBILIRUBINEMIA: CLINICAL APPROACH TO GILBERT’S SYNDROME |
| title_full | GALLSTONE DISEASE WITH UNCONJUGATED HYPERBILIRUBINEMIA: CLINICAL APPROACH TO GILBERT’S SYNDROME |
| title_fullStr | GALLSTONE DISEASE WITH UNCONJUGATED HYPERBILIRUBINEMIA: CLINICAL APPROACH TO GILBERT’S SYNDROME |
| title_full_unstemmed | GALLSTONE DISEASE WITH UNCONJUGATED HYPERBILIRUBINEMIA: CLINICAL APPROACH TO GILBERT’S SYNDROME |
| title_short | GALLSTONE DISEASE WITH UNCONJUGATED HYPERBILIRUBINEMIA: CLINICAL APPROACH TO GILBERT’S SYNDROME |
| title_sort | gallstone disease with unconjugated hyperbilirubinemia clinical approach to gilbert s syndrome |
| topic | Cholelithiasis Indirect Congenital Hyperbilirubinemia Cholecystectomy Jaundice |
| url | http://journalofsurgicalsciences.com/index.php/jss/article/view/260 |
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