Jaundice Question - Help!

[StressedMedStud]

FA 2012 - Page 362

In the Jaundice section it says that for obstructive jaundice you have:

1. direct hyperbilirubinemia

2. increased urine bilirubin - why is this ??? if its obstructive how does bilirubin make it from liver to urine?

3. Decreased urobilinogen - Why?


can someone explain this to me? Thanks!

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[StressedMedStud]

also how come for hemolytic anemia

you have hyperbilirubinemia is indirect - why?

why is urine bilirubin absent?

why is urine urobilinogen increased??

 

[beeitchness]

2. It's obstructive, so CB can't get out of the liver into CBD and into gut, so it's got to go somewhere --> backs up into the blood and then some of it makes it to the kidney and then urine

3. Again, it's obstructive, so CB can't get out of the liver into CBD and into gut, (where normally the bacteria there would convert CB into urobilinogen) so there's no urobilinogen in the gut. This means no urobilinogen reabsorbed into the blood (if it were reabsorbed, some of it would make it into the kidney too)

 

[StressedMedStud]

2. It's obstructive, so CB can't get out of the liver into CBD and into gut, so it's got to go somewhere --> backs up into the blood and then some of it makes it to the kidney and then urine

3. Again, it's obstructive, so CB can't get out of the liver into CBD and into gut, (where normally the bacteria there would convert CB into urobilinogen) so there's no urobilinogen in the gut. This means no urobilinogen reabsorbed into the blood (if it were reabsorbed, some of it would make it into the kidney too)

Thanks! Can you help me with my second post with hemolytic anemia?

 

[beeitchness]

also how come for hemolytic anemia

you have hyperbilirubinemia is indirect - why?

why is urine bilirubin absent?

why is urine urobilinogen increased??

you should be able to figure these out based on the explanation above...

 

[StressedMedStud]

you should be able to figure these out based on the explanation above...

so i get why urine bilirub is absent b/c you have indirect bili and that cannot be excreted inot urine.

why is urine urobilinogen increased in hemolytic? i believe in this problem you cant even make direct bilirubin so how is the gut bacteria going to convert the indirect bili into urobilinogen?

 

[beeitchness]

Alright:

Indirect because there is increased UCB. Where does the UCB come from? The spleen. (macrophages in spleen break the heme from lysed RBC down into UCB. This UCB binds albumin, gets to the liver to turn into CB).

Urine bilirubin is absent because the liver is intact and there is no obstruction. Bilirubin = CB, and CB goes into the unobstructed CBD, then to the gut, and never touches the blood.

Urine urobilinogen is increased because there is now lots of UCB flooding the liver, and the liver converts this into a lot more than normal CB. This increased amount of CB in the gut is converted to an increased amount of urobilinogen, some of which is absorbed into blood and gets into kidney - there is therefore an increased amount of urobilinogen in the urine

 

[StressedMedStud]

Alright:

Indirect because there is increased UCB. Where does the UCB come from? The spleen. (macrophages in spleen break the heme from lysed RBC down into UCB. This UCB binds albumin, gets to the liver to turn into CB).

Urine bilirubin is absent because the liver is intact and there is no obstruction. Bilirubin = CB, and CB goes into the unobstructed CBD, then to the gut, and never touches the blood.

Urine urobilinogen is increased because there is now lots of UCB flooding the liver, and the liver converts this into a lot more than normal CB. This increased amount of CB in the gut is converted to an increased amount of urobilinogen, some of which is absorbed into blood and gets into kidney - there is therefore an increased amount of urobilinogen in the urine

OMG your a genious! THANKS SOOOOOOOOOO MUCH ure the BEST!

 

[loveoforganic]

So, something I was putting off posting bc I didn't want to start a thread. Why do both direct and indirect bilirubin increase in hepatocellular jaundice? I would think the direct would be down

 

[Brotato]

So, something I was putting off posting bc I didn't want to start a thread. Why do both direct and indirect bilirubin increase in hepatocellular jaundice? I would think the direct would be down

Because the bilirubin you CAN convert into conjugated leaks into bloodstream due to damaged canaliculi (remember liver is damaged). The damaged liver also can't function at 100% to convert the bilirubin, so there is more unconjugated bilirubin floating around as a result. So you have both. Mixed hyperbilirubinemia.

 

[loveoforganic]

That makes sense, thanks. Was only thinking of the decreased hepatocyte function, not the permeable canaliculi