A twenty-year old student developed a flu-like illness with loss of appetite, na

Question

A twenty-year old student developed a flu-like illness with loss of appetite, nausea, and pain in the ght hypochondrium. On examination, the liver was just palpable and tender. Two days later he developed jaudice, dark urine and pale stools. on presentation 1 week later serum: total bili. conj. bili. albumin ALT AST Alk. Phos. GGT 38 25 40 950 624 79 20 230 umol 200umol/1 38g/1 760U/i 580U/l 230Un 215UA (C17) (35-50) (1-41) (1-38) (39-117) (7-49) urine (dipstick): bilirubin urobilinogen+ a). Suggest the most likely diagnosis b). Explain the changes in biochemical profile during the course of the illness I mark) (3 mark)

Explanation / Answer

a, Hyperbilirubinemia or jaundice
b, Bilirubin is the orange-yellow pigment derived from senescent red blood cells..It is a toxic waste product in the body..in the liver it is extracted and biotransformed mainly in the liver,and excreted in bile and urine..it is a bile pigment..high serum and urine bilirubin level present with jaundice..Erythrocyte become fragile,they easily detruct in the spleen,where the intra-capillary space is about 3micron compared to 8micron of cells..so spleen called as red blood cell graveyard due to dying erythrocytes..
   Breakdown of hemebiliverdin:
Biliverdin causing a change in the color of the molecules from blue-green(biliverdin to yello-red(bilirubin)after catabolic changes in the structure of tetrapyroles..this is rewsponsible for the progressive changes in color of a hematoma or bruise in damaged tissue changes clour become red-yello from dark blue finally to a yellow color..High bilirubin and albumin transported to the liver there catabolic reactions take place..bilirubin causing a changes in the color of the molecule from biliverdin to bilirubin..metabolism of bilirubin in the blood protein albumin dissolved in the blood..blood liverligandin(-)chnage ligandin(-) prevents bilirubin from going back to plasma..Bilirubin is conjugated into two step process to form bilirubin mono di glucuronide conjugation with glucoronates bilirubin Diglucoronide
Bilirubin physiology hemebiliverdin Heme oxygenase bilirubin biliverdin reductase..In the intestine small intestine conjugated bilirubin become unconjugated bilirubin form colorless urobilinogens and brown colored mesobilifusions..In the lower intestinal track the 3urobilinogens spontaneously oxidaze to produce the bile pigments,stercobalin,mesobilin,urobilin which are orange brown in color and are the major pigments of stool..so there will be high plasma concentration of bilirubin 3mg/dl,serum bilirubin will be more than 2.5mg/dl..conjugated bilirubin with high plasma concentration more than 0.5mg/dl..

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