Effective Counseling for Abnormal LFTs: A Focus on Gilbert's Syndrome

Initial Approach and Consultation

• Observation and Initial Thoughts

• Recognize the setting as a counseling station based on the patient's purpose for visiting (blood test results).

• Anticipate that the liver function test (LFT) is abnormal due to elevated unconjugated bilirubin levels.

• Keep the data gathering concise and focused.

• Critical Considerations

• Prioritize ruling out hepatitis as the most severe cause of abnormal LFTs.

• Address this during the consultation to avoid misdiagnosis.

Data Gathering

• Initial Questions

• Reason for the Blood Test: Start by asking why the test was conducted.

• Constitutional Symptoms:

• Fever

• Nausea

• Tummy pain

• Pruritus (itching)

• Jaundice

• Weakness

• Pale stools

• Short Symptom Inquiry: Limit to 3-4 key symptoms if the patient reports generally feeling healthy.

• PMAF TOSA Questions

• Past Medical History

• Medications: Crucial for understanding LFT derangement.

• Family History: Important to note any similar conditions in family members.

• Travel History: Relevant for Hepatitis A, especially related to recent outside food consumption.

• Diet

• Alcohol and Smoking: Ensure to signpost before asking these sensitive questions.

• Sexual History: If time permits, although less critical.

• Questions for Bloodborne Infections

• Recent tattoos

• Blood transfusions

• Recreational drug use (IV)

• Recent surgeries

Physical Examination

• Necessary Examinations

• General physical examination

• Vital signs check

• Abdominal examination: Check liver span and tenderness

Explaining Blood Test Results and Diagnosis

• Blood Test Explanation

• Simplify and explain the purpose of the tests:

• Liver Injury Tests: AST, ALT (indicate no liver damage)

• Liver Function Tests: Elevated unconjugated bilirubin indicating liver not functioning optimally

• Suspect Gilbert Syndrome based on exclusion of other causes.

• Introducing Gilbert Syndrome

• Wait for the patient's reaction after mentioning the diagnosis.

• Tailor further explanation based on their response.

• Simplify the explanation:

• Gilbert Syndrome is a genetic condition due to enzyme deficiency in the liver.

• This enzyme is needed for detoxifying old blood cells.

• Due to the deficiency, unconjugated bilirubin levels are elevated.

• Reassure the patient about the condition's seriousness.

• Further Investigations

• Recommend a liver ultrasound (USG) to examine the liver.

• Suggest a hepatitis screen to conclusively rule out hepatitis.

Patient Advice and Lifestyle Modifications

• Advice for Liver Care

• Avoid liver strain:

• Prevent starvation and dehydration.

• Manage stress effectively.

• Consume alcohol in moderation.

Concluding the Consultation

• Safety Netting

• Advise on signs to watch for and seek medical attention if experiencing:

• Weakness

• Yellowing of skin or eyes

• Any cirrhosis symptoms

• Follow-Up

• Schedule a follow-up appointment in two weeks to review test results and monitor progress.

• Encourage the patient to ask any questions or express concerns during the follow-up.

• Providing Information

• Hand out relevant leaflets and pamphlets for further reading and understanding.