Conjugation And Excretory Function Test Flashcards by ash .

Bilirubin must be excreted through liver?

Yes

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It is the end product of hemoglobin metabolism

Bilirubin

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Heme- containing proteins

Myoglobin
Catalase
Cytochrome oxidase

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Principal pigment in bile

Bilirubin

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Formed in destruction of heme- containing

Bilirubin

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Other names of bilirubin 1

Unconjugated
Water insoluble
Non polar
Indirect
Hemoglobilirubin
Slow reacting
Pre hepatic

(WUNSHIP)

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Other names of Bilirubin 2

Conjugated
Water soluble
Polar
Direct
Cholebilirubin
One minute/ prompt
Post hepatic/ hepatic/ obstructive/ regurgitative

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Reference value of conjugated bilirubin

0 - 0.2 mg/dl

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Reference value of unconjugated bilirubin

0.2-0.8 mg/dl

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Total bilirubin reference value

0.2-1.0

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Prolong conjugated bilirubin; bounded to albumin

Delta bilirubin

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Helps in monitoring the decline of serum bilirubin following cholecystectomy

Delta bilirubin

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Reference value of delta bilirubin

< 0.2 mg/dl

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It reacts with diazo reagent

Delta bilirubin

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Jaundice is caused by hypobilirunemia?

No. Hyperbilirubinemia

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Characterized by yellow discoloration of the skin, sclera, and mucus membranes

Jaundice

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Serum/plasma with yellow discoloration due to hyperbilirubinemia

Icterus

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Jaundice Total Bilirubin

3.0-5.0 mg/dl (visible jaundice)

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Overt jaundice

1.0-1.5 mg/dl

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Hemolytic jaundice, unconjugated bilirubin

Pre hepatic jaundice

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Caused by to much rbc destruction

Pre hepatic jaundice

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HDN; hemolytic anemia; malaria; BBB

Pre hepatic jaundice

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Lab findings:
Indirect bilirubin - increase
Direct & urobilinogen - normal
Urine bilirubin - negative

Pre hepatic jaundice

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Obstructive jaundice

Post hepatic jaundice

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Failure of bile to flow to the intestine or impaired Bilirubin excretion

Post hepatic jaundice

Lab findings: Indirect - normal Direct - increase Urobilinogen - decrease Urine bilirubin - positive Alkaphos - increase

Post hepatic

Hepatocellular combined jaundice

Hepatic jaundice

Caused of disorder of Bilirubin metabolism, transport defects, hepatocellular injury or destruction

Hepatic jaundice

Lab findings: Indirect & direct - increase Urobilinogen - decrease

Hepatic jaundice

Bilirubin transport deficit

Gilbert's syndrome

Impaired cellular uptake of bilirubin due to genetic mutation of UGT1A1 gene (chromosome 2)

Gilbert's syndrome

Mild icterus, no symptoms and predisposed acetaminophen toxicity

Gilbert's syndrome

Lab findings: Indirect bilirubin: 1.5-3.0 mg/dl

Gilbert's syndrome

Conjugation deficit

Crigler-najjar syndrome

Chronic non hemolytic unconjugated hyperbilirubinemia

Crigler-najjar syndrome

Complete UDPGT deficiency

Crigler-najjar syndrome type 1

Lab results of Crigler-najjar syndrome type 1

Indirect bilirubin: > 25 mg/dl

Symptoms of Crigler-najjar syndrome

Kernicterus Colorless bile

Partial deficiency of UDPGT

Crigler-najjar syndrome type 2

Lab results of Crigler-najjar syndrome type 2

Indirect bilirubin: 5-20 mg/dl

Presence of conjugation inhibitor

Lucey-driscoll syndrome

Familial form of unconjugated hyperbilirubinemia caused by circulating inhibitor of Bilirubin conjugation

Lucey-driscoll syndrome

Bilirubin excretion deficit

Dubin - johnson syndrome

Conjugated hyperbilirubinemia

Dubin - johnson syndrome

Defective excretion of direct bilirubin into the canaliculi caused by

Hepatocyte membrane defect

Intense dark pigmentation of the liver due to accumulation of lipofuscin pigment

Dubin - johnson syndrome

Similar to Dubin - johnson syndrome without the "black liver"

Rotor syndrome

Lab findings: Elevation in direct & total bilirubin Increase delta bilirubin

Rotor syndrome

Bilirubin methodology sample

Serum

Storage in Bilirubin methodology

RT : 2 days Ref (4degC) : 1 week Freezer (-20 degc) : indefinite

Interference in Bilirubin methodology

Iipemia - increase Hemolysis - decrease 30-50%/hr - decrease Loss if unprotected from light

Priniciple of bilirubin assay

Van Den Berg reaction

Measure conjugation and total bilirubin

Bilirubin assay

Diazotization of Bilirubin to form azobilirubin

Van den berg reaction

Methods in Bilirubin Assay

Evelyn and Malloy method Jendrassik and Grof method

Inherited disorders of Bilirubin metabolism

Gilbert's Crigler-najjar Lucey driscoll Dubin -johnson Rotor

Evelyn and Malloy method coupling accelerator

Methanol

Evelyn and Malloy method diazo reagent

Biuret bilirubin

0-1% sulfonilic acid + Hcl

Diazo A

0.5% sodium nitrate

Diazo B

1-5% HCl

Diazo blank

pH of diazo reagent

Near 1.0

Pink to purple azobilirubin

Evelyn and Malloy method

Most sensitive; popular technique for discreet analyzer

Jendrassik and Grof method

Accelerator of jendrassik and Grof method

Caffeine sodium benzoate

Buffer of jendrassik and Grof method

Sodium acetate

Terminates the accelerator and destroy excess diazo reagent

Ascorbic acid

Blue azobilirubin measured at 600 nm

Jendrassik and Grof method

Provides alkaline ph after addition of ascorbic acid

Alkaline tartrate solution

Increase indirect bilirubin

Hemolytic anemia G6PD Deficiency Gilbert's syndrome Crigler-najjar syndrome Hepatocellular disease Lucey-driscoll syndrome (HEGGCHEL)

Increase direct bilirubin

Biliary obstruction (gall stone) Pancreatic cancer Dubin - Johnson syndrome Alcoholic and viral hepatitis Biliary atresia Hepatocellular disease PHADBB

Colorless end product of Bilirubin metabolism that is oxidized by intestinal flora to urobilin

Urobilinogen

Urobilinogen collect of sample and specimen

Avoid light exposure 2 hr freshly urine or stool

Method in urobilinogen

Ehrlich method

P-DABA p - dimethylaminobenzenealdehyde

Urobilinogen urine reference value

0.1-1.0 Ehrlich unit

Urobilinogen stool reference value

75-275 Ehrlich unit

1 Ehrlich=

1 mg of urobilinogen

Test for hepatocellular function and potency of bile duct

Bromsulfophthalein dye extraction test

Principle of BSP dye extraction test

Injection of dye

Methods of administration of BSP

Rosenthal white method Mac donald method

Double collection method

Rosenthal white

Rosenthal white BSP dose

2mg/kg

Rosenthal white specimen collection

5 mins after BSP admin 30 mins after BSP admin

Rosenthal white reference value

After 5 minutes: 50% dye retention After 30 minutes : 0% dye retention

Single collection method

Mac donald method

Mac donald BSP dose

5 mg/kg

After 45 mins

Mac donald method

Mac donald reference value

After 45 mins: +/- 5% dye retention