A patient presents with unconjugated hyperbilirubinemia and presence of urobilinogen in urine. Which amongst the following is the least likely diagnosis:
Answer is D (Dubin Johnson Syndrome) Dubin Johnson syndrome is associated with conjugated hyperbilirubinemia & not unconjugated hjperbilirubinemia. Dubin Johnson Syndrome results from a hereditary defect in excretion of conjugated bilirubin across the canalicular membrane and leads to conjugated hyperbilirubinemia. Dubin Johnson syndrome is an inherited disorder charachterized by defective excretion of conjugated bilirubin from hepatocytes into biliary canaliculi. It thus presents with a clinical picture similar to obstructive jaundice with conjugated hyperbilirubinemia and absence of urobilinogen in urine. Hemolytic Anemia typically presents with unconjugated hyperbilirubinemia and elevated urinary urobilinogens. Gilbes syndrome and Cri2ler Najjar syndrome also present with unconjugated hyperbilirubinemia. Urinary Urobilinogens are however not elevated in these conditions. Urobilinogen may never the less be present in urine (N or in these conditions
Hemolytic jaundice
Crigler Najjar syndrome
Gilbe's syndrome
Dubin Johnson syndrome