Does conjugated bilirubin cause jaundice too?

[yanks26dmb]

I understand unconjugated bilirubin can cause jaundice. Can conjugated bilirubin also jaundice? Much of the literature I'm finding simply states "bilirubin". Thanks for the help.

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[AlteredScale]

I understand unconjugated bilirubin can cause jaundice. Can conjugated bilirubin also jaundice? Much of the literature I'm finding simply states "bilirubin". Thanks for the help.

I don't believe so. When you have conjugated bilirubin it is essentially excreted. However because some of that conjugated bilirubin is recycled I think an overall increase of conjugated bilirubin past its excretion rate will thus increase recycling and potentially cause a "back up" and leading to secondary unconjugated hyperbilrubinemia and thus cause jaundice. Based of some Medscape summaries it seems the exact pathogensis of how this occurs is still benign defined.


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[yanks26dmb]

I don't believe so. When you have conjugated bilirubin it is essentially excreted. However because some of that conjugated bilirubin is recycled I think an overall increase of conjugated bilirubin past its excretion rate will thus increase recycling and potentially cause a "back up" and leading to secondary unconjugated hyperbilrubinemia and thus cause jaundice. Based of some Medscape summaries it seems the exact pathogensis of how this occurs is still benign defined.


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But what if you have obstruction in the bile duct? You'd be pumping out loads of cb that then spills over. You don't think this could cause jaundice?

 

[AlteredScale]

But what if you have obstruction in the bile duct? You'd be pumping out loads of cb that then spills over. You don't think this could cause jaundice?

Oh I believe in OBD's you can get jaundice.

I think in that case it will basically lead an accumulation of bilirubin (both UCB and CB). What I've learned so for is that you will lose sterocoblin since you have an obstruction to move the CB into the duodenum and so most of conjugated bilirubin will be excreted via the urinary system (presenting as dark urine). The CB at that point wouldn't really contribute the jaundice. Over a period of time what will happen is that the overflow and back up of CB actually damages the cells that conjugate bilirubin eventually leading to an accumulation of UCB and causing jaundice.

In the description I talked about before this, I think that would happen more in the case of hemolytic anemia where you have a TON of CB. The enzymes in the liver that help with conjugation max out leading to increase UCB and (and this is my opinion and not too sure if this actually is what is going on) perhaps the excess CB increases the amount that is reconverted into UCB by microbiota also adding to the accumulation.