### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
hi, I have a 48-year old daughter, who has been under photo- therapy treatment for 8 days because of high blilirubine. finally after 15 days since her birth, this amount reached about 16. she took phenobarbital for 10 days, half of the 15mgrams pill on every 12 hours. and the test results now is : ast = 70 alt= 27 bilirubin total= 4.3 bilirubin direct=0.3 Gamma GT= 230 I would be grateful if I could have your remarks especially about Gamma GT. thank you, ali jafar

### output:

Hello and welcome to Chat Doctor, Jaundice (hyperbilirubinemia) is caused by increase in bilirubin levels. Jaundice occurs due to three different mechanisms. First the increased break down of RBC's in hemolytic anemia cause increase in conjugated bilirubin. Liver disease causes inability of the hepatocytes to conjugate conjugated bilirubin. Thirdly, any obstruction in flow of bilirubin from the liver to the duodenum causes accumulation of bilirubin and thus jaundice. There are various tests to determine the site of defect in the entire bilirubin metabolism and hence the cause of jaundice. Obstruction of the biliary tract which transmits bilirubin from liver to the duodenum will cause an increase in levels of alkaline phosphatase, gamma GY and 5-nucleotidase enzymes. So, gamma GT will be raised in disorders of the biliary tree most often alcohol liver disease. Thanks and take care Chat Doctor. 