Bilirubin is a yellowish pigment formed when red blood cells break down. It travels to the liver for processing and excretion. Elevated bilirubin levels, known as hyperbilirubinemia, indicate an underlying health issue. This article discusses managing elevated bilirubin in adults.
What High Bilirubin Means
Bilirubin is continuously produced from the breakdown of hemoglobin in old red blood cells. Initially, it exists as unconjugated (indirect) bilirubin, which is not water-soluble and binds to albumin for transport to the liver. In the liver, it converts to conjugated (direct) bilirubin, a water-soluble form that moves into bile and is eliminated through stool and urine.
Normal total bilirubin levels in adults range between 0.2 and 1.3 milligrams per deciliter (mg/dL). When bilirubin accumulates due to issues with its production, processing, or excretion, levels rise. This excess bilirubin can deposit in tissues, causing jaundice, a yellow discoloration of the skin, mucous membranes, and the whites of the eyes. Jaundice becomes noticeable when total bilirubin levels exceed 3 mg/dL.
Common Reasons for Elevated Bilirubin
High bilirubin levels are a symptom of various health conditions, categorized by where the problem occurs in the bilirubin processing pathway.
Pre-hepatic Causes
These originate before bilirubin reaches the liver. They involve accelerated red blood cell destruction, such as in hemolytic anemias, producing more unconjugated bilirubin than the liver can process. This overwhelms the liver, leading to a buildup of indirect bilirubin.
Intra-hepatic Causes
These involve issues within the liver itself, impacting its ability to process bilirubin. Liver diseases like hepatitis (viral, alcoholic, or autoimmune), cirrhosis, or fatty liver disease can impair liver function. Genetic conditions like Gilbert’s Syndrome also fall into this category, where the liver produces insufficient enzymes to properly conjugate bilirubin, leading to intermittently elevated unconjugated bilirubin.
Post-hepatic Causes
These occur after bilirubin has been processed by the liver, typically involving blockages that prevent bile, and thus conjugated bilirubin, from being excreted. Common culprits include gallstones obstructing bile ducts. Tumors in the bile ducts or pancreas, or inflammation of the pancreas (pancreatitis), can also impede bile flow, leading to a backup of conjugated bilirubin into the bloodstream.
Targeted Medical Treatments
Treating elevated bilirubin depends on identifying and addressing the underlying cause.
Pre-hepatic Conditions
For conditions like hemolytic anemia, the focus is on managing excessive red blood cell destruction. This may involve medications like corticosteroids to suppress an overactive immune system if the anemia is autoimmune, or addressing underlying infections.
Intra-hepatic Issues
Treatment targets the specific liver disease. Viral hepatitis may be managed with antiviral medications, while fatty liver disease often improves with lifestyle modifications. Autoimmune liver conditions may require immunosuppressants.
In Gilbert’s Syndrome, specific medical treatment is usually not necessary due to its benign nature, though managing triggers like stress or fasting can help.
Post-hepatic Causes
When these are identified, medical interventions aim to relieve the obstruction. Gallstones blocking bile ducts can often be removed using endoscopic retrograde cholangiopancreatography (ERCP), a minimally invasive procedure. If the blockage is due to tumors, surgical removal, such as a partial hepatectomy for liver-confined bile duct cancers or a Whipple procedure for pancreatic or distal bile duct tumors, may be necessary. A stent may also be placed in the bile duct to keep it open and allow bile to flow.
Lifestyle Support and Home Strategies
Beyond medical treatments, lifestyle adjustments can support liver health and aid in managing elevated bilirubin. Adopting a balanced diet is beneficial, emphasizing fruits, vegetables, whole grains, and lean proteins. Limiting excessive fats, processed foods, and refined sugars can reduce the burden on the liver. Adequate hydration supports overall bodily functions.
Avoiding substances known to irritate the liver is important. Alcohol consumption should be minimized or eliminated, as it can directly damage liver cells. Acetaminophen, when taken in excessive doses, can also be harmful to the liver.
Managing stress and ensuring adequate rest can contribute to liver well-being. Regular physical activity supports metabolic health and can indirectly benefit liver function. These lifestyle measures are supportive and complement medical treatment but do not replace it.
When to Seek Medical Advice
Self-diagnosing and attempting to self-treat elevated bilirubin levels are not appropriate. A healthcare professional must conduct a diagnosis, involving blood tests and a physical examination. Only a healthcare professional can determine the underlying cause and formulate a treatment plan.
Prompt medical attention is advised if you experience persistent jaundice, especially with other concerning symptoms. These include unusually dark urine, pale or clay-colored stools, severe abdominal pain, unexplained nausea or vomiting, or significant fatigue. Fever, chills, or any signs of confusion or disorientation with jaundice also warrant immediate medical evaluation. These symptoms indicate a serious underlying condition requiring timely intervention.