Dear Dr McGovern,

I had a very severe bout of Acute Hepatitis B in Dec and got very sick, finally in April my test results showed I was Surface Antigen Negative and Surface Antibody positive. I also have been vaccinated for Hep-A and I am Hep-C negative.

My question is, last week I went in to get some blood work done and was alarmed that my bilirubin is still 1.9 mg/dl, when I cleared the virus in April it was only 1.6 mg/dl, and I still have yellow loose stools. I should also point out that my ultrasound showed I have a fatty liver, but I am not overweight (quite the contrary) and I exercise 4 days a week. Furthermore all my other liver enzymes were normal. My Dr (Internal Medicine) doesnt seem to be worried about it and says that it is probably going to take awhile before I am back 100% but hasnt it been long enough? How long should I wait before I should be concerned? I am tempted to just go see an Gastroenterologis, on my own or am I over-reacting? Would a MRI or CAT Scan or biopsy of the liver be more helpfull in this situation? Thank you for any advice you could offer.

Sincerely, MC

You are asking excellent questions. I would like to reassure you that I don't think this elevated bilirubin is related to your prior hepatitis B since your seroconversion (antigen negative and antibody positive state) is an excellent sign.

I think your elevated bilirubin may be simply due to a syndrome called Gilbert's. Ask your doctor to "fractionate" the bilirubin into direct and indirect bilirubin. If there is more indirect bilirubin than direct bilirubin, you have a common enzyme abnormality which is not at all important or significant.

Dr. McGovern