Chronic hepatitis question

[Phloston]

---

Members do not see this ad.

Let's say a patient has chronic HepB or C.

During periods of stress, if he or she gets jaundice, is it due to conjugated or unconjugated hyperbilirubinaemia?

I feel like I've read some time ago that hepatocellular jaundice (i.e. not pre- nor post-hepatic) is usually due to defective bile secretion rather than uptake, so if I had to choose, I'd go with conjugated, but I just want someone's thoughts on this.

And what about acutely with HepA/E? Conjugated?

 

[phd89]

Let's say a patient has chronic HepB or C.

During periods of stress, if he or she gets jaundice, is it due to conjugated or unconjugated hyperbilirubinaemia?

I feel like I've read some time ago that hepatocellular jaundice (i.e. not pre- nor post-hepatic) is usually due to defective bile secretion rather than uptake, so if I had to choose, I'd go with conjugated, but I just want someone's thoughts on this.

And what about acutely with HepA/E? Conjugated?

I would agree its most probably Inc in CB. If UCB is inc it depends on the extent of damage to the liver. That it can no longer uptake ucb to conjugate. Everywhere ive looked online it leans towards inc in CB. But honestly its probably mixed as ive annotated in my FA with more inc in CB than UCB.

 

[Akarat]

In Harrison's Online, it says that viral hepatitis causes elevation of both conjugated bilirubin and unconjugated bilirubin. However, you'll have more conjugated bilirubin than unconjugated bilirubin.

From the text:

Elevation of the unconjugated fraction of bilirubin is rarely due to liver disease. An isolated elevation of unconjugated bilirubin is seen primarily in hemolytic disorders and in a number of genetic conditions such as Crigler-Najjar and Gilbert's syndromes (Chap. 42). Isolated unconjugated hyperbilirubinemia (bilirubin elevated but <15% direct) should prompt a workup for hemolysis. In the absence of hemolysis, an isolated, unconjugated hyperbilirubinemia in an otherwise healthy patient can be attributed to Gilbert's syndrome, and no further evaluation is required.

In contrast, conjugated hyperbilirubinemia almost always implies liver or biliary tract disease. The rate-limiting step in bilirubin metabolism is not conjugation of bilirubin, but rather the transport of conjugated bilirubin into the bile canaliculi. Thus, elevation of the conjugated fraction may be seen in any type of liver disease. In most liver diseases, both conjugated and unconjugated fractions of the bilirubin tend to be elevated.

 

[socrates89]

thanks for answering my post earlier, sorry for the late reply, but I guess Akarat and phd have got this covered already. I would agree with both of them on this one.

 

[Phloston]

Thanks for the replies. That helps a lot.

 

[deuterium198d]

I agree, it's mostly conjugated bilirubin. I remember reading that conjugated hyperbilirubinaemia occurs because the high level of oedema and inflammation present within the liver is enough to cause cholestasis.