Inheritable and congenital hyperbilirubinemia. Models for the study of drug metabolism

Pregnancy with gilbert syndrome - a case report

A primigravida presented to us at 32 weeks of gestation with vomiting, myalgia and jaundice. On examination she had icterus, she was dehydrated, uterus was corresponding to dates and the fetal heart rate was good. On evaluation, all the investigations were normal except mild unconjugated hyperbilirubinaemia and hypoglycaemia. Based on the above findings we derived at a diagnosis of Gilbert syndrome. Dehydration due to vomiting aggravated her jaundice. On correcting her dehydration jaundice resolved, patient improved symptomatically and was discharged two days later. She was later admitted at term and underwent emergency caesarian section in view of fetal distress. Mother and baby were fine postoperatively and was discharged on the fifth postoperative day Gilbert syndrome is rare in obstetric practice. Virtually all patients have decreased activity of Uridine diphosphate glucuronosyl transferase (UDPGT). The case is reported due to its rarity.

Molecular pathogenesis of intrahepatic cholestasis of pregnancy

Intrahepatic cholestasis of pregnancy (ICP) occurs mainly in the third trimester and is characterised by pruritus and elevated serum bile acid levels. ICP is associated with an increased perinatal risk and higher rates of foetal morbidity and mortality. Although the pathogenesis of this disease is unknown, a genetic hypersensitivity to female hormones (oestrogen and/or progesterone) or their metabolites is thought to impair bile secretory function. Recent data suggest that mutations or polymorphisms of genes expressing hepatobiliary transport proteins or their nuclear regulators may contribute to the development and/or severity of ICP. Unidentified environmental factors may also influence pathogenesis of the disease. This review summarises current knowledge on the potential mechanisms involved in ICP at the molecular level.

Crigler-Najjar type II disease inheritance: a family study

The inheritance of Crigler-Najjar type II disease is still contested. Autosomal dominant transmission with incomplete penetrance and autosomal recessive transmission have been proposed. We had the opportunity to study the hepatic activity of bilirubin uridinediphosphate glucuronyltransferase in parents whose first child had been affected by Crigler-Najjar type II disease. The demonstration of reduced activity of glucuronidation in the liver of both parents suggests autosomal recessive inheritance. The second infant of this couple was affected by the same disease and was treated with success by phenobarbital.

Dublin-Johnson syndrome with some unusual features in a Chinese family

Three cases of chronic nonhaemolytic jaundice with conjugated bilirubin in the serum are described in a Chinese family. Bromsulphthalein excretion tests gave results typical of the Dubin-Johnson syndrome. Liver histology in the proband showed cytoplasmic pigment of the lipofuscinmelanin variety, and intravenous cholecystography failed to show visualisation of the gallbladder. Unusual findings included onset during the neonatal period in the proband and the presence of some iron pigment in the hepatic cells with a little canalicular cholestasis. It is suggested that the infant may have had a concomitant nonspecific hepatitis. These cases are regarded as belonging to a disease group in which the Dubin-Johnson syndrome is at one end of a spectrum. The mode of inheritance is discussed.

A physiological approach to jaundice

An understanding of the production, transport, hepatic uptake, biotransformation and excretion of bile pigments is necessary for the rational investigation of a patient presenting with jaundice. These aspects are reviewed, and at each step of bilirubin metabolism the clinical abnormalities giving rise to jaundice are indicated.

Comparison of treatments for congenital nonobstructive nonhaemolytic hyperbilirubinaemia

A patient with Crigler-Najjar disease has survived with the help of phototherapy to the age of 2 years without neurological damage. Because long periods of phototherapy are a threat to normal development, a search was made for supplementary treatments. Cholestyramine and a high fat diet were effective, and possibly also aspartic acid. Maintenance therapy with cholestyramine allowed the amount of phototherapy given to be reduced.