Jaundice and Dubin Johnson

[Enzymes]

I encountered a UWorld question on Dubin Johnson. Question ID 101 for those interested. Basically the patient had intermittent jaundice with normal lab values. No other information was given.

I have always correlated jaundice with excess unconjugated bilirubin, since excess conjugated bilirubin is soluble and can be excreted in the urine. Can someone explain how you can determine that this is DJ syndrome just from intermittent jaundice? or why there is jaundice at all? Very confusing question to me.

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[Handinhand]

For this specific question it really doesn't matter if they're jaundiced or not. You need to look at the lab values they give you to determine first if the bili is direct or not.

In this question they give you total bili of 2.8 and a direct bili of 2.0 -- clearly an increase in conjugated bili. Next, you just need to know that the only cause really of a "relapsing and remitting" direct hyperbilirubinemia is Dubin-Johnson syndrome.

 

[Enzymes]

Oh shoot, I am an idiot. I read "normal lab values" and basically skipped it. Didn't even think to look at the bilirubin values. Lesson learned.

Appreciate your help. Thanks!