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Approximately twenty percent comes from other heme sources, however, including ineffective erythropoiesis , and the breakdown of other heme-containing proteins, such as muscle myoglobin and cytochromes. The unconjugated bilirubin then travels to the liver through the bloodstream. Because this bilirubin is not soluble, however, it is transported through the blood bound to serum albumin.
Once it arrives at the liver, it is conjugated with glucuronic acid to form bilirubin diglucuronide, or just "conjugated bilirubin" to become more water-soluble. The reaction is catalyzed by the enzyme UDP-glucuronyl transferase. This conjugated bilirubin is excreted from the liver into the biliary and cystic ducts as part of bile.
Intestinal bacteria convert the bilirubin into urobilinogen. From here urobilinogen can take two pathways. It can either be further converted into stercobilinogen , which is then oxidized to stercobilin and passed out in the feces , or it can be reabsorbed by the intestinal cells, transported in the blood to the kidneys , and passed out in the urine as the oxidised product urobilin.
Stercobilin and urobilin are the products responsible for the coloration of feces and urine, respectively. It is unclear how common jaundice is among adults. Most people presenting with jaundice will have various predictable patterns of liver panel abnormalities, though significant variation does exist. The typical liver panel will include blood levels of enzymes found primarily from the liver, such as the aminotransferases ALT, AST , and alkaline phosphatase ALP ; bilirubin which causes the jaundice ; and protein levels, specifically, total protein and albumin.
Other primary lab tests for liver function include gamma glutamyl transpeptidase GGT and prothrombin time PT. Some bone and heart disorders can lead to an increase in ALP and the aminotransferases, so the first step in differentiating these from liver problems is to compare the levels of GGT, which will only be elevated in liver-specific conditions. The second step is distinguishing from biliary cholestatic or liver causes of jaundice and altered laboratory results.
The former typically indicates a surgical response, while the latter typically leans toward a medical response. This remains the case in most liver disorders except for hepatitis viral or hepatotoxic.
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Levels of ALT and AST are not well correlated to the extent of liver damage, although rapid drops in these levels from very high levels can indicate severe necrosis. Low levels of albumin tend to indicate a chronic condition, while it is normal in hepatitis and cholestasis. Lab results for liver panels are frequently compared by the magnitude of their differences, not the pure number, as well as by their ratios. The AST:ALT ratio can be a good indicator of whether the disorder is alcoholic liver damage above 10 , some other form of liver damage above 1 , or hepatitis less than 1.
Bilirubin levels greater than 10x normal could indicate neoplastic or intrahepatic cholestasis. Levels lower than this tend to indicate hepatocellular causes.
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AST levels greater than 15x tends to indicate acute hepatocellular damage. Less than this tend to indicate obstructive causes. ALP levels greater than 5x normal tend to indicate obstruction, while levels greater than 10x normal can indicate drug toxic induced cholestatic hepatitis or Cytomegalovirus. GGT levels greater than 10x normal typically indicate cholestasis. Jaundice comes from the French jaune , meaning yellow, jaunisse meaning "yellow disease". From Wikipedia, the free encyclopedia. For the physiological event, see Ictal.
Guyton & Hall Physiology Review, 3e
For the songbird Icteria , see Yellow-breasted chat. Main article: Neonatal jaundice. World Journal of Gastroenterology. Archived from the original on 27 August Retrieved 13 August Oxford Textbook of Primary Medical Care. Oxford University Press. Archived from the original on Ferri's Clinical Advisor 5 Books in 1. Elsevier Health Sciences. Primary Care: A Collaborative Practice 4 ed.
February 23, Archived from the original on 8 August Primary care. American Family Physician. Chase publishing Company. Archived from the original on 7 August Retrieved 3 February Retrieved on Textbook of medical biochemistry 8th ed. Oxford Handbook of Clinical Specialties. World J. Oxford Handbook of Clinical Diagnosis. Osteopathic Family Physician. Molecular Pharmacology. An in vitro study". Photodermatology, Photoimmunology and Photomedicine. The Journal of Dermatology.
American Academy of Pediatrics.
Pediatrics in Review. Mount Sinai Expert Guides: Hepatology. Symptoms and signs : digestive system and abdomen R10—R19 , , Categories : Symptoms and signs: Digestive system and abdomen. Namespaces Article Talk. Views Read Edit View history.