Gilbert's syndrome

　　Gilbert's syndrome is mainly due to the obstruction of liver cells in taking up bilirubin and transporting bilirubin to the mitochondria, or insufficient activity of glucose醛酸转移酶 in liver cells, which causes an increase in intermediate bilirubin in the blood and leads to the disease. It is more common in males and can occur at any age, but it is most common between 15-20 years old.

　　Gilbert's syndrome can be complicated with bilirubin encephalopathy, congenital biliary atresia, neonatal hepatitis, viral hepatitis, and other conditions.

　　Neonatal bilirubin encephalopathy refers to acute brain damage in newborns within one week of birth due to the toxic effects of bilirubin. Chronic and permanent brain damage caused by the toxic effects of bilirubin is called kernicterus.

　　Biliary atresia (Biliary Atresia, BA) is a common pediatric surgical malformation characterized by the atresia and obstruction of bile ducts inside and outside the liver, and obstructive jaundice. The incidence rate is 1/5000-1/18000. The disease is mostly caused by developmental disorders of the liver and bile ducts during embryogenesis, but it is difficult to diagnose before birth. Kasai surgery is the first-line treatment for this disease, but ultimately, 70% of BA children who receive Kasai surgery successfully develop liver cirrhosis and need liver transplantation treatment.

　　Neonatal hepatitis (neonatal hepatitis syndrome) includes hepatitis caused by hepatitis B virus, cytomegalovirus, herpes simplex virus, coxsackievirus, and rubella virus, etc., and can also be caused by ECHO virus, EB virus, toxoplasma, listeriosis, or various bacteria. These pathogens can infect the fetus through the placenta, or can be infected during labor or after birth. A few cases are related to congenital metabolic defects.

　　It is advisable to avoid various triggers. When jaundice appears, liver enzyme inducers such as phenobarbital 60mg, three times a day, taken orally, can be used to increase the activity of glucose醛酸转移酶 in liver cells, thereby reducing the intermediate bilirubin in the blood.

　　The following is a brief introduction to the examinations and differential diagnoses that should be done for Gilbert's syndrome:

　　Firstly, examination:

　　Liver function test shows normal or slightly increased ALT, increased total serum bilirubin, mainly non-conjugated bilirubin, low calorie test (400 kcal/d) after 24 hours, the blood non-conjugated bilirubin exceeds the original level by more than 1 times; luminal test positive, that is, luminal 180mg/d, oral for three days, non-conjugated bilirubin decreases by more than 50%, even to normal. Red blood cell fragility test is normal, reticulocyte count is not high.

　　Imaging examination shows good gallbladder imaging.

　　Secondly, differentiation:

　　Pay attention to differentiate from hemolytic jaundice, obstructive jaundice, and hepatitis B.

　　Dietary taboos and preferences for Gilbert's syndrome.

　　Firstly, suitable diet for Gilbert's syndrome:

　　Firstly, eat light and more high-protein foods: fish, soy products, and dairy products are rich in protein and easy to digest and absorb, which can improve the body's ability to resist infection.

　　Secondly, eat more fresh vegetables and fruits: they are rich in various vitamins, can increase the content of VC, promote the activation of the immune system, increase the ability of white blood cells to phagocytize bacteria, and to some extent, can improve one's own resistance and enhance the body's immunity.

　　Secondly, eat more fungal foods: such as mushrooms, mushrooms, black fungus, monkey head fungus, straw mushrooms, etc., which can improve the function of immunity to varying degrees, promote the increase in the number of white blood cells, mononuclear macrophages, enhance phagocytic function, promote antibody production, mobilize the body's immune system, improve immunity, and play a positive role in reducing enzymes.

　　Secondly, avoid the following foods for Gilbert's syndrome:

　　Reduce the intake of and avoid fried, salted, greasy, and spicy foods with strong刺激性.

　　Gilbert's syndrome is mainly due to the obstruction of the uptake of bilirubin by liver cells and the transport of bilirubin to the mitochondria, or insufficient activity of the glucuronyl transferase in liver cells, which leads to an increase in indirect bilirubin in the blood. The prognosis of this disease is good, and generally no special treatment is required. Phenobarbital 40-18μg/d can quickly reduce the elevated blood bilirubin to normal levels.