Liver enzymes:

BILIRUBIN
BY-WANDE . A

1. DEFINITION 2. FORMS 3. NORMAL VALUES 4. CHANGE IN BILIRUBIN LEVELS 5. TESTS 6. JANDICE, Neonatal Jaundice

DEFINITION Bilirubin is the yellow breakdown product of normal heme catabolism. Heme is found in hemoglobin, a principal component of Red blood cells. Bilirubin is excreted in bile and urine and elevated levels may indicate certain diseases. It is responsible for the yellow discoloration in jaundice, the yellow color of bruises and urine and the brown color of stool.

Bilirubins main physiologic role is as a cellular antioxidant.

FORMS Bilirubin circulates in the blood stream in 2 forms: INDIRECT (OR UNCONJUGATED BILIRUBIN) And DIRECT (OR CONJUGATED BILIRUBIN)

INDIRECT BILIRUBIN- This form of Bilirubin does not dissolve in water (it is insoluble). Indirect Bilirubin travels through the blood (bound to albumin) to the liver, where it is changed to a soulbe form.

DIRECT BILIRUBIN- This occurs when unconjugated bilirubin in the liver is conjugated with Glucuronic Acid by the enzyme Glucuronyltransferase, making it soluble in water. Much of it goes into the bile and thus out into the small intestine and some of it remains in the large intestine where it is metabolized many times to end as Stercobilin.

NORMAL VALUES

Total bilirubin Direct bilirubin

Umol/L 5.1-17.0 1.0-5.1

Mg/dL 0.2-1.9, 0.3-1.0, 0.11.2 0-0.3, 0.1-0.3, 0.1-0.4

CHANGE IN BILIRUBIN LEVELS Mild rises in Bilirubin may be caused by- Hemolysis, Gilberts syndrome

Moderate rises in Bilirubin may be caused by- Drugs, Hepatitis, Chemotherapy, Biliary stricture

Very high rises in Bilirubin may be caused byNeonatal hyperbilirubinaemia, Bile-duct obstruction, Liver Cirrhosis.

TESTS 1. Urine analysis tests 2. In newborns, a blood sample is usually taken from the heel (heel stick) 3. Liver function tests for values of- Alanie transaminase, Aspartate transaminase, GammaGlutamyl transpeptidase, Alkaline phospatase

4. Blood film examination

JAUNDICE Also known as icterus, is a yellow discoloration of the skin,the sclera and other mucous membranes. It is caused by hyperbilirubinaemia, the concentration of bilirubin in the plasma >1.5mg/dL. There are 3 types of jaundice depending on the part of the physiological mechanism the pathology affects

Pre-hepatic- the pathology is located before the liver Hepaticliver the pathology is located within the

Post-hepatic- the pathology is located after the conjugation of Bilirubin in the liver

NEONATAL JAUNDICE This occurs in newborns with values >5mg/dL. It is common in about 70% of newborns and it can be both physiological and pathological.

Pathological jaundice of neonates can lead to many diseases such as- Brain damage (kernicterus), Hearing loss, Physical abnormalities and even death. Treatment- with Phototherapy or by a Blood transfusion.