Bilirubin metabolism




RBC

ProtoPorphiren

Globin

Iron

......
......

120

hemolysis

ReteculoEndothelial System

...

 ...

....

Haemoglobin is cleaved into haem & Globin which is hydrolysed into free AA

..

Globin

Amino Acid Pool

Iron is carried on transferrin to be reused

Bay Dad

..... Transferrin Iron

.....

Protoporpherin is then reduced into Biliverden

Biliverden

Then into Bilirubin

Bilirubin

 ..

...Albumin

Indirect bilirubin is water insoluble

Indirect

Albumin

so it is carried on albumin and called haemobilirubin or indirect bilirbin

.....

Or unconjugated bilirubin

haemobilirubin
indirect
bilirubin

unconjugated bilirubin

Indirect bilirubin cannot be filtrated from the kidney even in its exess so not present in urine in
haemolytic jaundice acholuric

Indirect bilirubin

Albumin kidney

bilirubin Liver albumin

.....

....

bilirubin liver ....

Indirect bilirubin is conjugated in the liver with 2 glucuronic acid molecules

Glucuronic
acid

Bilirubin

Now it is termed Direct or Conjugated or Cholibilirubin

Glucuronyl
transferase

Glucuronyl transferase

Direct or Conjugated or Cholibilirubin

Conjuged bilirubin can be filtrated in urine if it is increased as in obstructive & hepatocellular jaundice

intestine


Bile
Salt

Bile

Direct bilirubin (Bile pigment) is secreted into bile with bile salts

intestine Bile

Intestinal bacteria remove glucuronides and reduce bilirubin into stercobilirubin

stercobilinogen

Some of it is reabsorbed and go to the liver

Stercobilinogen

While some remain and become oxidized to stercobilinogen

Stool

) Stercobilin
(

Stool

 liver

A fraction of the absorbed part become excreted again into bileEntero-hepatic Ciculation

bile


Entero-hepatic Ciculation

Some go to the kidney and excreted as urobilinogen which is oxidized into urobilin

Urine Kidney

Urobilin Urobilinogen

 Bilirubin

Enterohepatic
circulation

Blood

Sterco
bilinogen

Urine

stool

Blood
Sterco
bilinogen

Urine

stool

Haemolytic
jaundice

indirect

Blood
Sterco
bilinogen

Urine

stool

Hepatocellular

jaundice

Blood

Urine

stool

Obstructive

Jaundice