Hi I can talk with you. Does she have diarrhea? Jaundice is yellowing of the skin, why do her doctors feel she is jaundiced? From Hepatitis A infection?

What about in her blood level? What are her symptoms right now?

Is this why she had the urine taken to rule out a urine infection?

Does she also have diarrhea?

What was stool tested for?

I'm sorry I'll ask in a better way, what organisms did they look for in the stool, parasites, or bacteria do you know?

So bilirubin is not supposed to be in the urine. When levels in the blood are high however this is where the body will excrete in as well as in the stool.

Thanks. Did she have a urine "dip test" only or was this test that was showing bilirubin done in a lab. Most dips are done directly in the doctors office as it is quick and easy to do.

Probably it was urobilinogen that was high correct? ( which is a byproduct of bilirubin)

So with no symptoms besides the tummy pain you have only basically the elevated bilirubin products in the urine that is concerning. Do you know if she was vaccinated against Hep A?

Has she had any blood in her urine or a dark color to it?

She had the 2 shots in the series?

The dark yellow color may just be more concentrated urine due to a change in how she is drinking. Sorry Hep A is a series of 2 shots, separated by at least 6 months. She got both shots from what you know?

How long and where are you going to in Europe?

Wow, when is it scheduled for?

So the most common cause for acute or quick onset jaundice in kids is really Hepatitis A infection (which may give just mild infection or make someone quite sick, usually stomach symptoms and jaundice). If she were to have this infection it would not be a good idea to travel at all as she may be contagious and infect others. It is possible but much less so, to get it after receiving both shots in the series.

Her symptoms are not at all exciting or serious and from what you say it sounds like she would be able to physically feel good enough to tolerate the trip....but

I would probably wait yes for the blood results. The reason being (they may have sent for Hep A antibodies to test for it particularly), but if it is not Hep A then what is it? All other reasons are somewhat more involved medically and really would be helpful to know sooner rather than later. You may find however (and I am so sorry about the vacation!!!) (maybe I could go instead just joking!) that the blood test is totally normal.

If this were the case the urine may have not been accurate. I have found many small elevations in the amount of urobilinogen in kids (especially in the dipsticks!) that are not clinically real. She is not clinically jaundiced thus maybe the blood level is not elevated then no scare for Hep A. Without knowing though it wouldn't be a good idea to take her no.

Call the lab that did the testing today (7/25) as I am in Spain and we have 1/2 hr more of 7/24...and push them to have a result for you.

Basically the time it takes to do the test is minimal, just the processing time is more. Did the doctor tell you her liver was enlarged at all?

This is good. I am wondering whether the blood level will be normal!

Do you have the reference levels of normal for the lab, or at least the units?

43 is not normal regardless of units though!

So the first two are levels of enzymes produced in the liver and when elevated they point to a problem here although ast can be from something else but all together these point to the liver.

Do you have a GGT?

So the next step for me would be to test for hepatitis serologies (A,B,C) as an infection with Hep A with her symptoms would be the most common.

But to answer your question as your heart is sinking no I would not take her on this beautiful European tour tomorrow! If she has Hep A she morally can't go as she may infect others, and she may get sicker herself and not enjoy it. If the reason the levels are high is something else (much more rare) then she needs to be closer to home. The results for the viral serologies you mean?

With levels like this she probably does have a liver that is enlarged but not all physicians are that good at feeling for one! Is she thin/heavy in terms of body habitus?

If it is Hep A then you need to relax and realize that the large large majority of people do not have permanent severe liver damage and clear the virus. So this may make it hard to feel for a liver edge. There is also an epidemic of fatty liver (due to overweight), that can cause hepatitis in kids these days but I have never seen liver enzyme levels this high with a fatty liver.

I'm surprised her eye whites are not yellow to you with this level of bilirubin.

What about her eyes or inside of her mouth?

Amazing, tells you how poor our eyes are at seeing it, (In babies as well!) For TB?

Influenza is viral and doesn't respond to Rifampin or antibiotics. How long has she been on it for?

We use Rifampin for severe infections or with other drugs for TB (in a "cocktail") which makes it more liver toxic, but it can affect the liver. There can also be immune response attacking the liver but I would expect her to physically be more sick with this if it was from this. This degree of elevation I haven't seen either with just drug.

Really I would keep this in mind, but look to other causes (Hep A) as more likely. I have had many patients on Tb cocktails including Rifampin and what we see is gradual increase in enzymes and again not to this level.

If she is better from her cold symptoms you may ask your doctor if you can stop it as her liver needs kind of minimal work right now. Here is a link to the US National institute of health patient info site for hep A http://www.nlm.nih.gov/medlineplus/ency/article/000278.htm

I would not recommend you take her on the trip no. Remember that vacations can always be repeated and although it will be financially painful to part with it! (and not to mention the spectacularness of the trip itself) but health is not to be played with. What you all want is to be healthy to enjoy many many more trips like this one!! I agree with you that it would be a good idea to stop it and her doctor should know.

You are so welcome. I hope that all turns out well with her! Feel free to write back and keep me updated as these question feeds stay open to additions for many days. Good luck to you and to her. You can always try to get your $ back from the travel company as frequently for medical purposes they will do this. You may qualify based on this!

All the best to you!