Internal Medicine

0521779407-08 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:47

Giardiasis Gilbert’s Syndrome 625

Routine

■Obtain follow-up stool exam (preferably with ELISA-based test) 2

weeks after therapy.

complications and prognosis

■Malabsorption, weight loss. IGA deficiency predisposes to more

severe and persistent disease.

Gilbert’s Syndrome...................................

WILLIAM E. BERQUIST, MD

history & physical

■incidence: 7–10% of population

■autosomal dominant inheritance

■presentation: prolonged neonatal jaundice or incidental laboratory

detection

■normal physical exam

tests

Basic Tests

■plasma bilirubin <3 mg/dl in non-fasting, non-hemolytic state;

nearly all unconjugated

■normal liver enzymes

Special Diagnostic Tests

■phenobarbital therapy (5mg/kg/d): decreased bilirubin in 7–10 days

■DNA insertional mutation of the UGT1A1 gene that conjugates

bilirubin

Other Tests

■liver biopsy: normal histology

■oral cholecystography: normal

differential diagnosis

■hemolysis

➣Crigler-Najjer syndrome type 2: much higher degree of jaundice

management

■hydration and avoid fasting; no other therapy or liver biopsy neces-

sary