Bilirubin is a product of hemoglobin metabolism

Its serum level reflects a balance between

Input from production of bilirubin

Hepatic/biliary removal or pigment

Bilirubin is conjugated within the liver to glucoronic acid

Only conjugated bilirubin can be excreted into bile

It then passes the intestines where it turns the with jaundice first then
abdominal pain then fever, that is not hepatitis, it is most likely an
obstructive disease.)

Arthralgias

Myalgias

Rash

Anorexia

Weight loss

Abdominal pain

Fever, pruritus

Changes in color of urine and stools

History of arthralgias and myalgias antedating jaundice

Suggests hepatitis, either viral or drug related

Jaundice associated with sudden onset of severe RUQ pain and shaking
shills\

Skin examination for icterus

As serum bilirubin levels rise, skin will eventually become yellow in light
skinned patients and even green if process is long standing

Green color is produced by oxidation of bilirubin to biliverdin

Darkening of urine

Patients often describe urine as tea or cola-colored

Sensitive indicator of increased bilirubin

Due to renal excretion of conjugated bilirubin fraction

Bilirubinuria indicates

Elevation of direct serum bilirubin fraction

Presence of liver disease

Choledocholithiasis and ascending cholangitis