Diagnostic Problem of Hyperbilirubinemia in Diabetes Mellitus Patient: Case Report

Hyperbilirubinemia in Diabetic Patients: Diagnostic Approach

Abstract

This case report presents a 57-year-old woman with worsening jaundice and associated symptoms, including abdominal pain, bloating, weakness, weight loss, and malaise. Clinical examination revealed icteric sclera, pale conjunctiva, and ascites. Laboratory findings showed elevated bilirubin, decreased albumin, increased alkaline phosphatase and gamma GT, severe dyslipidaemia, and poorly controlled diabetes. Imaging studies revealed hepatomegaly, ascites, and enlarged lymph nodes without biliary obstruction. Liver biopsy confirmed cirrhosis. The diagnostic approach for jaundice involves a comprehensive evaluation, including patient history, physical examination, laboratory tests, imaging studies, and liver biopsy. This case highlights the importance of considering non-alcoholic fatty liver disease (NAFLD) in patients with metabolic disorders, particularly type 2 diabetes mellitus (T2DM). NAFLD is strongly associated with T2DM, with diabetes driving the progression to cirrhosis and increasing mortality risk. Treatment for NAFLD primarily focuses on lifestyle changes, particularly weight reduction. For diabetic patients with NAFLD, specific diabetes medications like pioglitazone and GLP-1 receptor agonists may provide extra advantages. This case highlights the crucial role of liver biopsy in confirming diagnoses and evaluating disease severity in complex liver conditions, particularly those associated with metabolic disorders. It also emphasizes the importance of a multidisciplinary approach in managing patients with NAFLD and associated metabolic conditions to improve outcomes and prevent disease progression.