Serum conjugated bilirubin

Possible increase in serum conjugated bilirubin Obstruction of bile flow commonly due to common bile duct stone or pancreatic carcinoma Failure of bile secretion Extrahepatic cholestasis Intrahepatic cholestasis... 

In patients with Dubin-Johnson syndrome, in whom fecal bile acid output is not grossly impaired (222) and in whom serum-conjugated bilirubin level is elevated, serum bile acid concentrations are within normal limits. This clearly indicates that secretory mechanisms are not the same for conjugated bile acids and conjugated bilirubin (218). 

In contrast, in a retrospective analysis of 292 neonates who received parenteral nutrition with lipid emulsions containing omega-3 fatty acids for more than 1 day, 104 (36%) developed cholestasis after a mean of 22 days, with a conjugated bilirubin concentration over 34 pmol/l 31 had a serum conjugated bilirubin concentration over 100 pmoUl and 13 developed liver failure 4 underwent transplantation and 5 died of hepatic disease [385]. The authors suggested that in the absence of definitive evidence of efficacy, as well as increased costs, it is difficult to justify the routine use of lipid... 

A7b. Arvan, D. A., and Ritz, A., Measurement of serum albumin by the HABA-dye technique A study of the effect of free and conjugated bilirubin, of bile acids, and of certain drugs. Clin. Chim. Acta 26, 505-516 (1969). 

Wl. Weber, A. P., and Schalm, L., Quantitative separation and determination of bilirubin and conjugated bilirubin in human serum. Clin, Chim. Acta 7, 805-810 (1962). 

Conjugated and unconjugated bilirubin concentrations in serum may be measured via the van den Bergh reaction. The conjugated bilirubin reacts directly with diazotized sulfanylic acid and is thus termed "direct bilirubin." Unconjugated (albumin-bound) bilirubin does not react with the reagent unless the serum is treated with alcohol, and its concentration is thus termed "indirect bilirubin." The determination of direct and indirect serum bilirubin, as well as... 

Biochemical data for his serum were as follows total bilirubin 99.2 pmol/L (normal is 3.4-20.5 pmol/L) conjugated bilirubin 15-4 pmol/L (normal is 0-6.8 pmol/L) alanine aminotransferase 125 U/L (normal is 0-40 U/L) and lactate dehydrogenase 570 U/L (normal is 120-250 U/L). 

B. Poor liver uptake or poor conjugation of the unconjugated bilirubin. This likewise will result in increased serum unconjugated bilirubin. Decreased excretion of bilirubin in the bile will result in light-colored stools, as the by-product of urobilinogen metabolism, stercobilin, contributes to the normal brown color of stool. 

The clinical picture is characterized by chronic or intermittent jaundice with values between 2 and 6 mg/dl, and in rare cases between 6 and 12 mg/dl. With acute icteric episodes, values can be in excess of 20 mg/dl. The proportion of conjugated bilirubin in the serum is about 60%, almost exclusively in the form of diglucuronidated bilirubin. The liver or spleen are only occasionally enlarged (50-60% or 10-15% of cases, respectively). Both the laboratory values and the bile acids in the serum are normal cholestasis is absent. Coagulation factor VII is frequently reduced (approx. 60% of cases). In more pronounced jaundice, bilirubinuria and urobilinogenuria are in evidence. Excretion of coproporphyrin I in the... 

Bilirubin Serum bilirubin shows a pronounced and varied increase, although the conjugated bilirubin does not rise at all, or only minimally, since uptake and conjugation remain intact for a considerable period of time. 

The clinical stage commences with the occurrence of jaundice. The level of bilirubin in the serum and, especially, the duration of the icteric phase, correlate with the morphological degree of severity. Here, direct (conjugated) bilirubin mostly predominates, (s. tab. 22.5)... 

Conjugated hyperbilirubinemias are due to intra- or extra-hepatic reduction to bile flow (cholestasis) with spillage of conjugated bilirubin into the bloodstream, which may occur from injury to the endothelial cells lining bile ductules or from reverse pinocytosis, by the hepatocytes. Since the serum bilirubin is mostly the water-soluble glucuronide, bilirubinuria is usually present. 

A15. Arias, I. M., Studies of chronic familial non-hemolytic jaundice with conjugated bilirubin in the serum with and without an unidentified pigment in the liver cells. Am. /. Med. 31, 510-518 (1961). 

Conjugated bilirubin in rat serum and human amniotic fluid LiChrosorb SI 60, S Jim Gradient from 0 to 1% methanol in chloroform/acetic acid (99.5 0.5) in 6 min UV 430 nm 144... 

The rise in serum total bilirubin occurs as a result of the inability of the infected liver to conjugate bilirubin and of a partial or complete occlusion of the hepatic biliary drainage ducts caused by inflammatory swelling within the liver. In fulminant hepatic failure, the serum bilirubin level may exceed 20 mg/dL, a poor prognostic sign. 

In rats orally administered 57 mg/kg (equivalent to a human dose of 1 g/kg) of an aqueous extract of cola nut every other day for 18 weeks, a decrease in total body weight and an increase in absolute weights of liver, kidney, brain, and testis were observed. Total protein, RNA, and DNA of these organs were significantly depressed, and serum levels of total and conjugated bilirubin were significantly decreased (Ikegwuonu et al. 1981). 

Patients with partial obstruction have elevated serum alkaline phosphatase and gamma-glutamyl transpeptidase. The serum of patients with clinically apparent jaundice shows increases in total and conjugated bilirubin. Alkaline phosphatase levels are increased to more than three times normal. Elevated alkaline phosphatase levels are accompanied by increases in gamma-glutamyl transpeptidase and 5 nucleotidase, usually disproportionate to serum transaminase levels. Serum aminotransferase levels usually are less than 300 lU/ml. 

We have observed decreases in serum bilirubin levels of up to 50% and appearance of conjugated bilirubin products in the native bile up to nine weeks post transplantation, indicating metabolic activity in the transplanted cells. While promising, these results were difficult to consistently reproduce, and successful hepatocyte transplantation was limited by cell injury and hypoxia at the time of transplantation. Cell death prevented consistently adequate cell mass engraftment to replace function. 

Glucuronyl transferase appears in the serum in patients with hepatic necrosis. Thus, even when the liver transferase level is depressed, the serum enzyme can still conjugate bilirubin in vitro. In such cases it is possible that the activity of the blood enzyme is the source of conjugated bilirubin found in the serum in patients suffering from hepatic necrosis associated with impaired hepatic glucuronyl transferase activity. 

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