Bilirubin and Jaundice

Bilirubin is a yellow compound that occurs in the normal catabolic pathway that breaks
down haem. The body's clearance of waste products that arise from the destruction of aged
red blood cells.
Bilirubin is excreted in bile and urine.
RBC broken down to and haem broken down to Biliverdin the biliverdin reductase converts
this to unconjugated Bilirubin; it is toxic and it is lipid soluble so is carried with albumin in
blood stream.
In liver, unconjugated Bilirubin has glucuronic acid making it water soluble.
Conjugated Bilirubin goes with bile into the small intestine; in the ilium it gets converted to
urobilinogen by removing glucuronic acid. 10% of this is re-absorbed, the rest gets
converted to stercobilin – giving faeces its brown colour.
The re-absorbed urobilinogen either goes into the bile or goes to kidneys which gets
converted to urobilin – going urine it yellow colour.

Pathology:

Any part of the above gets damaged causes jaundice.

Pre-hepatic: anything that causes an increased rate of haemolysis
– Causes:
o Genetic: Gilberts syndrome, sickle cell anaemia, spherocytosis, thalassemia,
pyruvate kinase deficiency, and glucose 6-phosphate dehydrogenase
deficiency

Hepatocellular:
– Causes
o acute or chronic hepatitis, hepatotoxicity, cirrhosis, drug-induced hepatitis
and alcoholic liver disease

Post hepatic:
– Obstructive jaundice, is caused by an interruption to the drainage of bile containing
conjugated bilirubin in the biliary system
– Causes
o gallstones in the common bile duct, and pancreatic cancer in the head of the
pancreas. Also, a group of parasites known as "liver flukes" can live in the
common bile duct
o strictures of the common bile duct, biliary atresia (narrow/blocked in
childhood), cholangiocarcinoma (bile duct cancer), pancreatitis, cholestasis of
pregnancy, and pancreatic pseudocysts.
Diagnosis of jaundice:
– Liver test: ALP, AST,ALP, GGT and PT.