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Bilirubin Metabolism - Pathophysiology • Conjugated Bilirubin • Unconjugated Bilirubin By Dr. Khushboo Gala @LouLectures #Bilirubin #Metabolism #Pathophysiology
Bilirubin Metabolism ... Pathophysiology • Conjugated ... Bilirubin • Unconjugated ... #Bilirubin #Metabolism
Biochemistry and Metabolism of Bilirubin Hemolysis → Hemoglobin → Heme → Biliverdin → Unconjugated Bilirubin (a.k.a. "indirect
Biochemistry and Metabolism ... → Biliverdin → Unconjugated ... Conjugation → Conjugated ... common bile duct Unconjugated ... #Biochemistry #Metabolism
Jaundice Evaluation Algorithm #Diagnosis #Management #EM #IM #GI #Jaundice #Hyperbilirubinemia #Workup #Evaluation #Differential #Algorithm #Direct #Indirect
Algorithm #Diagnosis #Management ... Direct #Indirect #Conjugated ... #Unconjugated #
Classification of Jaundice Unconjugated hyperbilirubinemia (predominantly indirect bilirubin) • Increased bilirubin production (eg, hemolytic anemias, hemolytic reactions,
Classification of Jaundice Unconjugated ... Crigler-Najjar syndrome ... Dubin-Johnson syndrome ... , Rotor syndrome ... #unconjugated #
Jaundice - Differential Diagnosis Algorithm Pre-Hepatic - Unconjugated Hyperbilirubinemia Increased Production • Hemolysis • Ineffective Erythropoiesis • Hematoma Decreased
Pre-Hepatic - Unconjugated ... • Gilbert's Syndrome ... Crigler-Najjar Syndromes ... II) Hepatic - Conjugated
Inherited Non-hemolytic Disorders of Hyperbilirubinemia == Disorders of Conjugation == Gilbert Syndrome: • 5-10% of the population
Conjugation == Gilbert Syndrome ... hyperbilirubinemia syndrome ... , intermittent unconjugated ... UGT1A1 activity • Unconjugated ... and unconjugated
Liver Chemistry Tests - AST, ALT, Alkaline Phosphatase and Bilirubin Metabolism AST and ALT: • AST: liver
and Bilirubin Metabolism ... insult Bilirubin metabolism ... cytochromes) • Unconjugated ... MRP2 transports conjugated ... Tests #Laboratory #Metabolism
Causes of Metabolic Alkalosis - Differential Diagnosis Chloride depletion syndromes • Gastrointestinal losses -
Causes of Metabolic ... Chloride depletion syndromes ... - Gitelman syndrome ... • Liddle syndrome ... <2 mmol/L) #Metabolic
High Anion Gap Metabolic Acidosis (HAGMA) - Differential Diagnosis - GOLDMARK Glycols - ethylene and propylene glycol Oxoproline
High Anion Gap Metabolic ... during hypoxic metabolism ... with short bowel syndrome ... #Anion #Gap #Metabolic
Hypokalemia - Differential Diagnosis Algorithm Extra-renal Losses: • Normal Acid-Base: Low intake • Metabolic acidosis: Gl tract
Low intake • Metabolic ... Renal Losses: • Metabolic ... SAME, Cushing Syndrome ... diuretics, Bartter syndrome ... , Gitelman syndrom
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