Which of the following is true of Gilbert's syndrome? 1) inheritance is autosomal recessive 2) serum conjugated bilirubin levels are elevated 3) serum bilirubin levels are decreased by fasting 4) serum bilirubin levels are decreased by liver enzyme inducers 5) there is bilirubinuria

Which of the following is true of Gilbert's syndrome? 1) inheritance is autosomal recessive 2) serum conjugated bilirubin levels are elevated 3) serum bilirubin levels are decreased by fasting 4) serum bilirubin levels are decreased by liver enzyme inducers 5) there is bilirubinuria
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Answers-4 Gilbert's syndrome is inherited in autosomal dominant fashion and affects 2-5% of the population. UDP glucuronyl transferase levels are reduced leading to an unconjugated hyperbilirubinaemia. Whilst serum bilirubin levels are elevated the other LFTs are normal. Jaundice deepens after a period of fasting or intercurrent illness but bilirubin levels are reduced by enzyme inducers such as phenobarbitone. As unconjugated bilirubin is tightly bound to albumin it cannot cross the glomerulus and so is not found in the urine. This contrasts with the bilirubin-glucuronide-albumin complex formed in patients with cholestatic jaundice (and raised conjugated bilirubin levels) where 1% of the complex is dialysable and although most of the bilirubin is reabsorbed in the proximal tubule some bilirubin is detectable in the urine.
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