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diagnosis differential hepatology algorithm management hematology jaundice workup causes liver gastroenterology hyperbilirubinemia pathophysiology urine conjugated laboratory treatment anemia biliary hemolytic
Bilirubin Metabolism - Pathophysiology • Conjugated Bilirubin • Unconjugated Bilirubin By Dr. Khushboo Gala @LouLectures #Bilirubin #Metabolism #Pathophysiology
Bilirubin Metabolism ... Pathophysiology • Conjugated ... Bilirubin • Unconjugated ... Bilirubin By ... LouLectures #Bilirubin
Biochemistry and Metabolism of Bilirubin Hemolysis → Hemoglobin → Heme → Biliverdin → Unconjugated Bilirubin (a.k.a. "indirect
→ Biliverdin → Unconjugated ... Bilirubin (a.k.a ... Conjugation → Conjugated ... common bile duct Unconjugated ... , and conjugated
Liver Function Tests (LFTs) - Aspartate aminotransferase (AST) - Alanine aminotransferase (ALT) - Alkaline
transpeptidase (GGT) - Bilirubin ... - Unconjugated ... Indirect) - Conjugated
Inherited Non-hemolytic Disorders of Hyperbilirubinemia == Disorders of Conjugation == Gilbert Syndrome: • 5-10% of the population
, intermittent unconjugated ... UGT1A1 activity • Unconjugated ... bilirubin in the ... and unconjugated ... bilirubin • Defect
Classification of Jaundice Unconjugated hyperbilirubinemia (predominantly indirect bilirubin) • Increased bilirubin production (eg, hemolytic anemias, hemolytic reactions,
Classification of Jaundice Unconjugated ... predominantly indirect bilirubin ... • Increased bilirubin ... ) • Impaired bilirubin ... #unconjugated #
Inherited forms of Hyperbilirubinemia Major pathways involved in bilirubin production, conjugation, and excretion. Notes: Both the UB
pathways involved in bilirubin ... for transporting unconjugated ... bilirubin into ... Decreased UGT1A1 - Unconjugated ... absent UGT1A1 - Unconjugated
Laboratory Testing in Hemolytic Anemia Intravascular vs Extravascular Hemolysis Reticulocytes Unconjugated bilirubin LDH Peripheral smear Haptoglobin Urine hemosiderin Urine hemoglobin Carboxyhemoglobin #Hemolytic #Anemia #Laboratory #Testing #workup
Reticulocytes Unconjugated ... bilirubin LDH
Liver Chemistry Tests - AST, ALT, Alkaline Phosphatase and Bilirubin Metabolism AST and ALT: • AST: liver
Phosphatase and Bilirubin ... initial insult Bilirubin ... cytochromes) • Unconjugated ... MRP2 transports conjugated ... bilirubin into
Liver Function Tests (LFTs) - Normal Values and Interpretation Alanine aminotransferase (ALT/SGPT) - Liver, cardiac & skeletal
in bone Total bilirubin ... TBili) Direct bilirubin ... (Conjugated/DBili ... Indirect bilirubin ... (Unconjugated)
Hemolytic Anemias - Differential Diagnosis Algorithm Signs of anemia and hemolysis: • ↓ Haptoglobin • ↑ LDH
• ↑ Indirect / unconjugated ... bilirubin • ↑
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