upper GI obstruction and jaundice

[Fungi121]

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Anyone want to explain how an upper GI obstruction can lead to jaundice, specifically, indirect hyperbilirubinemia? My book says it "increases enterohepatic circulation" but it's not clicking with me...

 

[ChessMaster3000]

Anyone want to explain how an upper GI obstruction can lead to jaundice, specifically, indirect hyperbilirubinemia? My book says it "increases enterohepatic circulation" but it's not clicking with me...

I have never heard of this phenomenon

 

[thehundredthone]

Like this?

It's unlikely that UGI obstruction would cause jaundice, and even LGI obstruction sees jaundice as a later complication.

 

[iBS1972]

This is strange, because posthepatic jaundice is almost always associated with direct bilirubinemia, not indirect.

If anyone is able to find an explanation or association, please comment.

 

[akuko2]

My 2 cents: it seems obvious that any obstruction that blocks the hepatopancreatic duct would lead to a backup of conjugated bilirubin into the bloodstream, however if there is an upper GI obstruction and conjugated bilirubin is not allowed to flow past, I believe it can be deconjugated by gut bacteria and then by virtue of being more lipid soluble can be reabsorbed via the GI mucosa leading to an eventual buildup of serum indirect bilirubin.

Biliary Obstruction Workup: Laboratory Studies, Imaging Studies, Procedures

Let me know what y'all think.

 

[iBS1972]

My 2 cents: it seems obvious that any obstruction that blocks the hepatopancreatic duct would lead to a backup of conjugated bilirubin into the bloodstream, however if there is an upper GI obstruction and conjugated bilirubin is not allowed to flow past, I believe it can be deconjugated by gut bacteria and then by virtue of being more lipid soluble can be reabsorbed via the GI mucosa leading to an eventual buildup of serum indirect bilirubin.

Biliary Obstruction Workup: Laboratory Studies, Imaging Studies, Procedures

Let me know what y'all think.

Yes! You are absolutely correct--I totally forgot about this. Thank you!
Deconjugation of bile acids by intestinal lactobacilli.

However, I would use this as example as an FYI for future reference, while sticking to post-hepatic obstruction as a cause of direct hyperbilirubinemia for exams.

 

[akuko2]

However, I would use this as example as an FYI for future reference, while sticking to post-hepatic obstruction as a cause of direct hyperbilirubinemia for exams.

I'll save it in my my head as an esoteric example so I can pimp future medstudents lol