Bilirubin Metabolism and Pathogenesis of Jaundice
Sources and Formation of Bilirubin
Bilirubin metabolism is a crucial biochemical process involving production, conjugation, and elimination. Jaundice results from disruptions in this pathway.
Bilirubin Metabolism and Pathogenesis of Jaundice
Sources and Formation of Bilirubin
Bilirubin is a yellow pigment produced during the breakdown of heme. It primarily originates from senescent red blood cells undergoing degradation in the reticuloendothelial system.
Metabolism of Bilirubin
Pre-Hepatic Phase
Unconjugated bilirubin is released into the bloodstream where it binds to albumin and is transported to the liver.
Hepatic Phase
Hepatocytes uptake the bilirubin, conjugate it with glucuronic acid via UDP-glucuronyltransferase, making it water-soluble.
Post-Hepatic Phase
Conjugated bilirubin is excreted into bile and eliminated through feces and urine. Its final metabolites include stercobilin and urobilin.
Pathogenesis of Jaundice
Jaundice results from elevated bilirubin levels in the blood due to either excessive production, impaired hepatic processing, or obstructed excretion.
Pre-Hepatic Causes
- Hemolysis (e.g., sickle cell anemia)
- Ineffective erythropoiesis
Hepatic Causes
- Hepatitis (viral, alcoholic)
- Cirrhosis
- Genetic disorders (Gilbert's syndrome)
Post-Hepatic Causes
- Biliary obstruction (gallstones, tumors)
- Cholestasis
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