The case records of all patients with an elevated serum bilirubin seen in a hospital group over a consecutive 3-month period were analysed. A judgement was made as to whether the hyperbilirubinaemia had been adequately explained and the aetiology was recorded. Appropriate investigations performed and associated liver function tests were noted.
Eleven per cent. of all bilirubins were elevated. Of 415 patients studied no explanation for the hyperbilirubinaemia was given in 106 (26%). In 287 patients the hyperbilirubinaemia was explained, but in 165 (57%) it was not primarily related to liver or biliary disease. The bilirubin was usually higher and associated liver function tests were more likely to be abnormal when primary hepatobiliary pathology was present. An explanation was more likely to be available when the bilirubin was high (>24 μmol/l) (1·4 mg/100 ml). The commonest overall cause of hyperbilirubinaemia was cardiorespiratory failure (30%).
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