Jaundice: Review Questions

1. An 18-year-old male college freshman is referred to a gastroenterologist for evaluation of painless jaundice. He initially presented to a campus health center for evaluation of a flu-like illness with high fevers, where mild scleral icterus was noted. Initial laboratory studies revealed a normal complete blood count, normal alkaline phosphatase level, and normal alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels as well as a total serum bilirubin of 4 mg/dL and direct serum bilirubin of 0.4 mg/dL. Serologic testing for hepatitis was negative. At this visit, the flu-like illness has spontaneously resolved, and repeat laboratory testing reveals that total serum bilirubin has returned to normal. He has not taken any medications for his illness. What is the most likely cause of this patient’s elevated serum bilirubin level? (A) Acute viral hepatitis (B) Gilbert’s syndrome (C) Primary biliary cirrhosis (PBC) (D) Primary sclerosing cholangitis (PSC) (E) Transient biliary obstruction caused by a gallstone