4 WhaL ls Lhe cllnlcal slgnlflcance of abnormal LoLal blllrubln values CorrelaLe wlLh prehepaLlc hepaLlc and posL

hepaLlc [aundlce
lncreased LoLal blllrubln causes [aundlce and can slgnal a number of problems
1 rehepaLlc lncreased blllrubln producLlon 1hls can be due Lo a number of causes lncludlng
haemolyLlc anemlas and lnLernal hemorrage
2 PepaLlc problems wlLh Lhe llver whlch are reflecLed as deflclency ln blllrubln meLabollsm (eg
reduced hepaLocyLes upLake lmpalred con[ugaLlon of blllrubln and reduced hepaLocyLe secreLlon of blllrubln)
Some examples would be clrrhosls and vlral hepaLlLls
3 osL hepaLlc obsLrucLlon of blle ducLs reflecLed as deflclency ln blllrubln excreLlon ( obsLrucLlon can
be locaLlon elLher wlLhln Lhe llver or ln Lhe blle ducL)

rehepaLlc [aundlce
resulLs when an excesslve amounL of blllrubln ls presenLed Lo Lhe llver of meLabollsm such as
haemolyLlc anemla 1hls Lype of [aundlce ls characLerlzed by uncon[ugaLed hyperblllrublnemla Powever Lhe
serum blllrubln level rarely exceeds 3mg/dL because Lhe normal llver ls capable of handllng mosL of Lhe
overload uncon[ugaLed blllrubln ls noL waLer soluble and ls bound albumln so LhaL lL ls noL fllLered ouL of Lhe
blood by Lhe kldney 1herefore blllrubln wlll noL appear ln Lhe urlne ln Lhls Lype of [aundlce 1he largesL
percenLage of [aundlce paLlenLs has Lhe hepaLlc Lype PepaLlc [aundlce may resulL from lmpalred cellular upLake
from deLecLlve con[ugaLlon or from abnormal secreLlon of Lhe blllrubln by Lhe llver cell
PepaLlc [aundlce
Lhe mosL common dlsorders are dlffuse hepaLocellular damage and llver cell desLrucLlon 1hls condlLlon
may be caused by vlral hepaLlLls PepaLlLls produced by Loxln (drugs such as phosphorus or organlc arsenlcals)
ln hepaLocellular dlsease Lhe urlnary excreLlon of uroblllnogen maybe lncreased desplLe a reducLlon ln Lhe
amounL of blllrubln LhaL may reach Lhe guL 1hls seemlng paradox ls explalned by Lhe fallure of Lhe damaged
hepaLlc cells Lo remove Lhe absorbed uroblllnogen from Lhe porLal veln blood Lhe uroblllnogen ln Lhe blood
Lhen becomes avallable for excreLlon by Lhe kldney
osL PepaLlc !aundlce
resulL from lmpalred excreLlon of blllrubln caused by medlcal obsLrucLlon of Lhe flow of blle lnLo Lhe
lnLesLlnes 1hls may be due Lo Lhe gallsLones or any Lumor When blle cease Lo flow ln Lhe lnLesLlnes Lhere ls rlse
ln Lhe serum level of con[ugaLed blllrubln and sLool loses lLs source normal plgmenLaLlon and becomes clay
colored Con[ugaLed blllrubln appears ln Lhe urlne and uroblllnogen levels decrease





3 ln Labular form dlfferenLlaLe con[ugaLed blllrubln from uncon[ugaLed Lype
Uncon[ugated 8|||rub|n

Con[ugated 8|||rub|n
WaLer lnsoluble WaLer soluble

lrom hemoglobln (hemo)

CrlglnaLes from Lhe llver
CannoL be excreLed ln Lhe urlne LxcreLed Lhrough urlne and feces

lndlrecLreacLlng ulrecLreacLlng
8equlres Lhe addlLlon of alcohol ln Lhe dlazo
reacLlon Lo allow color formaLlon
8eacLs ln Lhe dlazo reacLlon wlLhouL Lhe
addlLlon of alcohol
An lncrease occurs wlLh hemolysls llver dlsease
cholesLasls and fasLlng ln horses
An lncrease lndlcaLes cholesLasls (noL speclflc cause)
parenchymal llver dlsease (lnLerferes wlLh blllary)
sepsls (lnflammaLory cyLoklnes lmpalr blllary
excreLlon) blle sludglng (ln caLs wlLh dehydraLlon or
anorexla) and physlcal obsLrucLlons Lo blle flow ln Lhe
blllary sysLem



6 WhaL ls uelLa 8lllrubln? uescrlbe lLs characLerlsLlcs and cllnlcal slgnlflcance
uelLa blllrubln con[ugaLed blllrubln LhaL ls cavalenLly bound Lo albumln 1hls fracLlon of blllrubln ls seen
only when Lhere ls slgnlflcanL hepaLlc obsLrucLlon 8ecause Lhe molecule ls aLLached Lo albumln lL ls Loo large Lo
be fllLered by glomerulus and excreLed ln Lhe urlne 1hls fracLlon of blllrubln when presenL wlll reacL ln Lhe
mosL laboraLory meLhods as con[ugaLed blllrubln
1hls complex ls non Loxlc and has been suggesLed as a measure of Lhe recovery phase ln obsLrucLlve llver
dlsease 8lllrubln blndlng occurs aL Lwo Lo Lhree slLes on albumln one wlLh a hlgh afflnlLy for blllrubln and one or
Lwo slLes 1hls blllrubln can be dlsplaced by drugs such as sallcylaLe whlch can cause nerve damage