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    Bilirubin Metabolism and Jaundice: Marie Bernadette C. Digo, RMT, DTA

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    Marie Bernadette Digo
    Bilirubin is a toxic waste product derived from the breakdown of red blood cells. It is conjugated in the liver and excreted in bile and urine. Elevated bilirubin causes jaundice, seen as yellowing of the skin and eyes. There are three phases of bilirubin metabolism: pre-hepatic, where bilirubin is formed; hepatic, where it is conjugated; and post-hepatic, where it is excreted. Jaundice can be pre-hepatic from excessive red blood cell breakdown, hepatic from liver problems impairing bilirubin clearance, or post-hepatic from bile duct obstruction.

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    Bilirubin Metabolism and Jaundice: Marie Bernadette C. Digo, RMT, DTA

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    Marie Bernadette Digo
    27 views15 pages
    Bilirubin is a toxic waste product derived from the breakdown of red blood cells. It is conjugated in the liver and excreted in bile and urine. Elevated bilirubin causes jaundice, seen as yellowing of the skin and eyes. There are three phases of bilirubin metabolism: pre-hepatic, where bilirubin is formed; hepatic, where it is conjugated; and post-hepatic, where it is excreted. Jaundice can be pre-hepatic from excessive red blood cell breakdown, hepatic from liver problems impairing bilirubin clearance, or post-hepatic from bile duct obstruction.

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    BILIRUBIN-DEMO TEACHING

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    Bilirubin is a toxic waste product derived from the breakdown of red blood cells. It is conjugated in the liver and excreted in bile and urine. Elevated bilirubin causes jaundice, seen as yellowing of the skin and eyes. There are three phases of bilirubin metabolism: pre-hepatic, where bilirubin is formed; hepatic, where it is conjugated; and post-hepatic, where it is excreted. Jaundice can be pre-hepatic from excessive red blood cell breakdown, hepatic from liver problems impairing bilirubin clearance, or post-hepatic from bile duct obstruction.

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    © All Rights Reserved
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    27 views15 pages

    Bilirubin Metabolism and Jaundice: Marie Bernadette C. Digo, RMT, DTA

    Uploaded by

    Marie Bernadette Digo
    Bilirubin is a toxic waste product derived from the breakdown of red blood cells. It is conjugated in the liver and excreted in bile and urine. Elevated bilirubin causes jaundice, seen as yellowing of the skin and eyes. There are three phases of bilirubin metabolism: pre-hepatic, where bilirubin is formed; hepatic, where it is conjugated; and post-hepatic, where it is excreted. Jaundice can be pre-hepatic from excessive red blood cell breakdown, hepatic from liver problems impairing bilirubin clearance, or post-hepatic from bile duct obstruction.

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    of 15

    BILIRUBIN

    METABOLISM AND
    JAUNDICE
    Marie Bernadette C. Digo, RMT, DTA
    What is Bilirubin?

    ◦ Bilirubin is the orange-yellow pigment derived


    from old or damaged red blood cells
    ◦ It is a toxic waste product in the body
    ◦ It is mainly conjugated in the liver and is excreted
    in the bile and urine
    ◦ Elevations of bilirubin in the blood and urine are
    commonly associated with Jaundice.
    FORMATION OF
    BILIRUBIN
    ◦ Primary site of synthesis: SPLEEN
    ◦ Secondary site of synthesis: LIVER & BONE MARROW
    INTRAVASCULAR
    PATHWAY FOR RBC
    DESTRUCTION (BLOOD
    VESSEL)

    EXTRAVASCULAR
    PATHWAY FOR RBC
    DESTRUCTION
    (LIVER, BONE MARROW
    AND SPLEEN)
    3 PHASES OF BILIRUBIN
    METABOLISM
    ◦ PRE- HEPATIC PHASE
    ◦ HEPATIC PHASE
    ◦ POST- HEPATIC PHASE
    RBCs breakdown: 120 days

    PRE-HEPATIC Degraded by macrophages


    PHASE releasing hemoglobin
    molecules
    HEMOGLOBIN

    BROKEN DOWN TO AMINO


    ACIDS RE-ENTERS BLOOD FOR
    HEME GLOBIN ERYTHROPOIESIS

    ALBUMIN

    RE-ENTERS BLOOD FOR


    UNCONJUGATED ERYTHROPOIESIS
    BILIRUBIN IRON

     NOT RECYCLED
     YELLOWISH ORANGE
    COLOR
     LIPID SOLUBLE
    UNCONJUGATED
    BILIRUBIN

    HEPATIC PHASE GLUCORONIC


    ACID

    UDP-GLUCORONYL
    TRANSFERASE

    GLUCORONIC
    ACID

    CONJUGATED
    BILIRUBIN
    GLUCORONI
    CONJUGATED C ACID
    BILIRUBIN
    (WATER
    EXCRETED BY SOLUBLE)
    POST-HEPATIC THE LIVER IN
    BILE

    PHASE
    UROBILINOGEN CB
    5% TRANSPORTED BY
    THE BLOOD TO THE
    KIDNEYS
    UROBILIN
    UROBILINOGEN CB
    5% WILL PARTICIPATE
    IN ENTEROHEPATIC BACTERIA
    UROBILINOGEN
    CYCLE UROBILINOGEN

    UROBILINOGEN
    BACTERIA
    10-15% RE-ABSORB 85-90% OXIDIZE
    BY THE BLOOD BY BACTERIA
    BOUND TO FORMING
    ALBUMIN STERCOBILIN
    BROWN
    PIGMENT IN
    FECES
    JAUNDICE
    What is Jaundice?
    ◦ Elevated levels of orange-yellow pigment called
    bilirubin.
    ◦ Yellowish discoloration of the skin, sclera and
    mucous membranes due to increased levels of
    bilirubin and deposition of bile pigments.
    ◦ Becomes clinically evident when the serum
    bilirubin level exceeds 2.5mg/dl
    ◦ The equilibrium between bilirubin production and
    clearance is disturbed
    ◦ NOT a disease, but rather a sign that occur in many
    different diseases.
    Types of Jaundice
    ◦ PRE-HEPATIC JAUDICE (Hemolytic Jaundice)
    ◦ HEPATIC JAUNDICE
    ◦ POST-HEPATIC JAUNDICE (Obstructive Jaundice)
    PRE-HEPATIC JAUNDICE
    ◦ AKA Hemolytic Jaundice
    ◦ Excessive breakdown of RBC
    ◦ Plasma membrane of RBC are defective
    ◦ Results from excess production of bilirubin (beyond the livers ability to
    conjugate it) following hemolysis.
    ◦ Congenital: Sickle cell Anemia, Thalassemia, Erythroblastosis Fetalis
    ◦ Acquired: Trauma, Vit B12 Deficiency, Folic Acid Deficiency, Malaria,
    Chemical and toxins
    HEPATIC JAUNDICE
    ◦ Impaired uptake, conjugation, or secretion of bilirubin
    ◦ Problem of hepatocyte in the liver
    ◦ Congenital: Wilson’s dse, Gilbert’s dse, Hemochromatosis
    ◦ Acquired: Viral Hepatitis, Alcoholic hepatitis, Sepsis, Malnutrition,
    trauma
    POST-HEPATIC JAUNDICE
    ◦ AKA Obstructive jaundice
    ◦ Obstruction of bile in the biliary portion of the hepatobiliary system
    which cause increased level of bilirubin.
    ◦ Characterized by pale stools, and dark urine
    ◦ In a complete obstruction, urobilin is absent from the urine.
    ◦ Congenital: Cystic fibrosis, Biliary atresia, Pancreatic biliary obstruction
    ◦ Acquired: Cholecytitis, Trauma, Pancreatitis, Tumors, Gallstones.
    THANK YOU
    FOR LISTENING!
    GOD BLESS 
    Marie Bernadette C. Digo, RMT, DTA

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