hyperbilirubinemia and liver damage

[MudPhud20XX]

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So the way Kaplan biochem explained is as below:

1. In bile duct obstrcuction: only direct bilirubin is elevated --> which makes sense

2. In hepatic damage: both direct and indirect bilirubin are elevated --> which I don't get.

Shouldn't you just expect the indirect bilirubin to be increased?

With hepatic damage, the liver lose its ability to conjugate bilirubin to make direct bilirubin, right? So you shouldn't expect direct bilirubin to be decreased? What am I missing here?

Many thanks in advance.

 

[ChessMaster3000]

So the way Kaplan biochem explained is as below:

1. In bile duct obstrcuction: only direct bilirubin is elevated --> which makes sense

2. In hepatic damage: both direct and indirect bilirubin are elevated --> which I don't get.

Shouldn't you just expect the indirect bilirubin to be increased?

With hepatic damage, the liver lose its ability to conjugate bilirubin to make direct bilirubin, right? So you shouldn't expect direct bilirubin to be decreased? What am I missing here?

Many thanks in advance.

they way I think about it is not every hepatocyte is injured. If you think about it that way, everything falls into place. Also, the increased direct has nothing to do with hepatocyte damage but everything to do with adjacent biliary vessel damage.