Bilirubin Metabolism and Jaundice: Marie Bernadette C. Digo, RMT, DTA
Bilirubin Metabolism and Jaundice: Marie Bernadette C. Digo, RMT, DTA
Bilirubin Metabolism and Jaundice: Marie Bernadette C. Digo, RMT, DTA
METABOLISM AND
JAUNDICE
Marie Bernadette C. Digo, RMT, DTA
What is Bilirubin?
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
ALBUMIN
NOT RECYCLED
YELLOWISH ORANGE
COLOR
LIPID SOLUBLE
UNCONJUGATED
BILIRUBIN
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