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    Bilirubin

    Uploaded by

    Victor Ekuta
    The document summarizes bilirubin production, processing, excretion, and lab values. Bilirubin is produced through the breakdown of heme in hemoglobin and other heme proteins. It is transported in an unconjugated form bound to albumin in the blood and processed in the liver where it is conjugated. Conjugated bilirubin is excreted in bile and intestines where bacteria convert it to urobilinogen and its derivatives which are excreted in urine and feces. Normal and critical bilirubin lab values are provided for adults, children, and newborns.

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    Bilirubin

    Uploaded by

    Victor Ekuta
    108 views5 pages
    The document summarizes bilirubin production, processing, excretion, and lab values. Bilirubin is produced through the breakdown of heme in hemoglobin and other heme proteins. It is transported in an unconjugated form bound to albumin in the blood and processed in the liver where it is conjugated. Conjugated bilirubin is excreted in bile and intestines where bacteria convert it to urobilinogen and its derivatives which are excreted in urine and feces. Normal and critical bilirubin lab values are provided for adults, children, and newborns.

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    The document summarizes bilirubin production, processing, excretion, and lab values. Bilirubin is produced through the breakdown of heme in hemoglobin and other heme proteins. It is transported in an unconjugated form bound to albumin in the blood and processed in the liver where it is conjugated. Conjugated bilirubin is excreted in bile and intestines where bacteria convert it to urobilinogen and its derivatives which are excreted in urine and feces. Normal and critical bilirubin lab values are provided for adults, children, and newborns.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    108 views5 pages

    Bilirubin

    Uploaded by

    Victor Ekuta
    The document summarizes bilirubin production, processing, excretion, and lab values. Bilirubin is produced through the breakdown of heme in hemoglobin and other heme proteins. It is transported in an unconjugated form bound to albumin in the blood and processed in the liver where it is conjugated. Conjugated bilirubin is excreted in bile and intestines where bacteria convert it to urobilinogen and its derivatives which are excreted in urine and feces. Normal and critical bilirubin lab values are provided for adults, children, and newborns.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 5

    Bilirubin Production

    Heme proteins
    myoglobin, cytochromes
    (20 to 25%)
    ferritin

    Hemoglobin
    (70 to 80%)

    Erythroid cells

    Heme

    (250 to 400 mg/day)


    3 [O]
    Heme oxygenase
    3+
    Fe + CO

    apoferritin

    Biliverdin
    NADPH + H+
    NADP+

    Biliverdin reductase

    Bilirubin

    albumin

    indirect
    unconjugated
    pre-hepatic
    Eric Niederhoffer
    SIU-SOM

    Bilirubin Processing
    albumin-Bilirubin
    ligandin

    albumin
    hepatocyte

    ligandin-Bilirubin

    2 UDP-glucuronate
    ER

    UDP-Glucuronyl
    transferase

    2 UDP

    Bilirubin diglucuronide
    bile (gall bladder)

    direct
    conjugated
    post-hepatic

    Bilirubin Excretion
    Bilirubin diglucuronide
    2 glucuronate

    liver

    Bacterial enzyme

    Intrahepatic
    urobilinogen cycle

    Bilirubin
    8H
    intestines

    Bacterial enzyme

    Urobilinogen

    kidneys

    Urobilin

    urine

    Stercobilin

    feces

    kidneys

    Bacterial enzymes

    Stercobilinogen

    Bilirubin Lab values


    Bilirubin form

    Normal value

    Total (elderly, adult, child)

    0.1 to 1.0 mg/dL

    (newborn)

    1.0 to 12.0 mg/dL

    Critical value (adult)

    >12 mg/dL

    (newborn)
    Pre-hepatic, unconjugated, indirect

    >15 mg/dL
    0.0 to 0.8 mg/dL

    Post-hepatic, conjugated, direct

    0.0 to 0.25 mg/dL

    Fecal urobilinogen

    40 to 280 mg/day

    Urine

    0.0 to 0.02 mg/dL

    Conjugated bilirubin - water soluble direct reaction with dyes


    Unconjugated bilirubin - water insoluble alcohol is needed for dye (indirect) reaction
    Observe the color changes associated with heme degradation by
    watching the progress of a bruise (dark red to green to yellow).

    Review Questions

    How is bilirubin produced?

    How is bilirubin transported in the blood?

    How is bilirubin eliminated from the body?

    What is the intrahepatic urobilinogen cycle?

    What clinical observations would you make


    concerning a patients inability to process
    bilirubin normally?

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