A 57-year-old white man presents for evaluation of an asymptomatic elevation in bilirubin detected on a chemistry panel during an annual physical examination. Thirty years ago, he had abnormal liver function tests attributed to use of an unknown medication that resolved when the drug was discontinued. He reports no jaundice, pruritus, or family history of liver disease and takes no medications. He drinks 1 alcoholic beverage daily (≈100 g/week). On physical examination, blood pressure was 108/63 mm Hg, pulse rate was 61 beats per minute, and body mass index (calculated as weight in kilograms divided by height in meters squared) was 23.4. His liver was 7.0 cm by percussion and nontender, sclera were anicteric, there was no stigmata of chronic liver disease, and splenomegaly was absent. The examination was otherwise unremarkable. His laboratory values are reported in the Table.
VanWagner LB, Green RM. Evaluating Elevated Bilirubin Levels in Asymptomatic Adults. JAMA. 2015;313(5):516–517. doi:10.1001/jama.2014.12835
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