From the Guidelines
High direct bilirubin levels indicate that your liver is having trouble excreting bilirubin into the bile, and you should consult a healthcare provider promptly for proper diagnosis and treatment. This condition, known as conjugated hyperbilirubinemia, requires medical evaluation to determine the underlying cause. Common causes include bile duct obstruction (from gallstones, tumors, or strictures), certain medications, liver diseases like hepatitis or cirrhosis, and genetic disorders 1.
Possible Causes and Symptoms
Some possible causes of high direct bilirubin levels include:
- Bile duct obstruction
- Liver diseases like hepatitis or cirrhosis
- Genetic disorders
- Certain medications Symptoms of high direct bilirubin levels may include:
- Jaundice (yellowing of skin and eyes)
- Dark urine
- Light-colored stools
- Abdominal pain or fatigue
Diagnosis and Treatment
Diagnosis of high direct bilirubin levels typically involves blood tests, imaging studies, and possibly liver function tests 1. Treatment will depend on the specific cause and may include addressing bile duct blockages, changing medications, or managing underlying liver conditions. While waiting for your appointment, it is recommended to avoid alcohol and medications that can stress the liver, stay hydrated, and maintain a healthy diet low in processed foods.
Important Considerations
It is essential to note that total bilirubin should be fractionated to determine the percentage derived from direct bilirubin, and elevated alkaline phosphatase should be confirmed to be of hepatobiliary origin with a gamma glutamyl transferase and/or alkaline phosphatase isoenzyme fractionation 1. Additionally, the presence of fever, right upper quadrant pain, and jaundice coupled with elevated inflammatory blood tests may assist in assigning causality to cholangitis.
Special Considerations
In certain cases, such as cholestatic jaundice, phototherapy may be used to treat high bilirubin levels, but it is crucial to monitor for potential complications, including the bronze infant syndrome 1. However, the most recent and highest quality study 1 provides the best guidance for the management of high direct bilirubin levels.
From the Research
Causes of High Direct Bilirubin
- High direct bilirubin can be caused by defects in bile clearance proteins or the inability of bile to reach the small bowel through bile ducts 2
- Liver lesions of any cause can reduce hepatocyte cell number and impair the uptake of indirect bilirubin from plasma and diminish direct bilirubin transport and clearance through the bile ducts 2
- Cholestatic disorders, such as choledocholithiasis and neoplastic obstruction of the biliary tree, can cause conjugated hyperbilirubinemia 3
Evaluation of High Direct Bilirubin
- Evaluation of patients with high direct bilirubin starts with a careful history and physical examination, followed by directed imaging of the biliary tree and liver 4, 5
- Initial laboratory evaluation should include assays for bilirubin (total and fractionated), a complete blood count, aspartate transaminase, alanine transaminase, gamma-glutamyltransferase, alkaline phosphatase, albumin, prothrombin time, and international normalized ratio 5, 3
- Ultrasonography of the abdomen, computed tomography with intravenous contrast media, and magnetic resonance cholangiopancreatography are first-line options for patients presenting with jaundice, depending on the suspected underlying etiology 5
Treatment of Underlying Causes
- Ursodeoxycholic acid (UDCA) is the only drug currently approved for the treatment of patients with primary biliary cirrhosis (PBC) and has anticholestatic effects for several other cholestatic syndromes 6
- UDCA has several potential mechanisms of action, including stimulation of hepatobiliary secretion, inhibition of apoptosis, and protection of cholangiocytes against toxic effects of hydrophobic bile acids 6