34 year old male.

Seen for treatment of superficial skin wounds resulting from a shotgun accident while grouse hunting. Family physician noted slight pallor, jaundice, and scleral icterus.

History of cholecystectomy five years prior to admission. At that time the patient was told he had Gilbert's syndrome. He stated he had always had "low blood," and that his father and paternal grandfather both had "liver ailments."

Physical Exam

Somewhat pale yellowish skin with scattered small surface wounds--mostly over the face, scalp and upper extremities.

Moderate scleral icterus.

Spleen palpable 3 cm below the left costal margin.

CBC & Diff