Advanced Pathophysiology – GI Latest 2024
With Accurate Answers
A manifestation of liver dysfunction is impaired protein synthesis. What are the three phenomenons
related to that?
1. clotting factor deficiency: bleeding, elevated PT (vitamin K related anemia).
2. hypoalbuminemia: edema, ascites.
3. inadequate antibody production. (immunoglobulin = protein)
What is indirect bilirubin?
= unconjugated bilirubin
- elevated with increased RBC breakdown or impaired liver uptake
- bound by albumin so not found in urine
(Bilirubin, the end product of heme catabolism, is transported to the liver to be conjugated and
excreted via the bile. Most of the bilirubin in blood is in transit from the tissues to the liver, in the
unconjugated form, bound to albumin. Only small amounts of conjugated bilirubin are normally
found in blood, and it is believed that the usual analytical methods tend to overestimate it in the low
reference range. Bilirubin determinations are reported in two fractions, the "conjugated" and the
"total.")
What is direct bilirubin?
= conjugated bilirubin
- elevated with impaired excretion of bilirubin from liver
- water soluble, so is found in urine
1
, How is bilirubin transported?
unconjugated bilirubin --> liver --> conjugated bilirubin --> gall bladder --> bile production in the
gallbladder to digest fat in the GI tract
How is bilirubin excreted?
- Bile
- some excreted in the stool (brown)
- Some reabsorbed into the blood stream
- very small amount, if any, excreted in the urine
(Bilirubin is excreted in bile and urine.
- the yellow color of bruises
- the yellow color of urine (via its reduced breakdown product, urobilin)
- the brown color of faeces (via its conversion to stercobilin)
- the yellow discoloration in jaundice.)
If the liver gets fibrotic and not working well which bilirubin level would be elevated?
conjugated bilirubin (hepatitis, fibrosis, and cirrhosis) . In hepatitis, fibrosis, and cirrhosis, high
amounts of unconjugated bilirubin means the liver cells are not conjugating bilirubin normally,
causing it to build up in the blood (abnormal RBC breakdown).
If we have a plug so bile can't get out of the liver (e.g. cholelithiasia), what happened to bilirubin?
increased conjugated bilirubin. --> Jaundice
(The liver converts ammonia to urea for excretion in the urine.)
2
With Accurate Answers
A manifestation of liver dysfunction is impaired protein synthesis. What are the three phenomenons
related to that?
1. clotting factor deficiency: bleeding, elevated PT (vitamin K related anemia).
2. hypoalbuminemia: edema, ascites.
3. inadequate antibody production. (immunoglobulin = protein)
What is indirect bilirubin?
= unconjugated bilirubin
- elevated with increased RBC breakdown or impaired liver uptake
- bound by albumin so not found in urine
(Bilirubin, the end product of heme catabolism, is transported to the liver to be conjugated and
excreted via the bile. Most of the bilirubin in blood is in transit from the tissues to the liver, in the
unconjugated form, bound to albumin. Only small amounts of conjugated bilirubin are normally
found in blood, and it is believed that the usual analytical methods tend to overestimate it in the low
reference range. Bilirubin determinations are reported in two fractions, the "conjugated" and the
"total.")
What is direct bilirubin?
= conjugated bilirubin
- elevated with impaired excretion of bilirubin from liver
- water soluble, so is found in urine
1
, How is bilirubin transported?
unconjugated bilirubin --> liver --> conjugated bilirubin --> gall bladder --> bile production in the
gallbladder to digest fat in the GI tract
How is bilirubin excreted?
- Bile
- some excreted in the stool (brown)
- Some reabsorbed into the blood stream
- very small amount, if any, excreted in the urine
(Bilirubin is excreted in bile and urine.
- the yellow color of bruises
- the yellow color of urine (via its reduced breakdown product, urobilin)
- the brown color of faeces (via its conversion to stercobilin)
- the yellow discoloration in jaundice.)
If the liver gets fibrotic and not working well which bilirubin level would be elevated?
conjugated bilirubin (hepatitis, fibrosis, and cirrhosis) . In hepatitis, fibrosis, and cirrhosis, high
amounts of unconjugated bilirubin means the liver cells are not conjugating bilirubin normally,
causing it to build up in the blood (abnormal RBC breakdown).
If we have a plug so bile can't get out of the liver (e.g. cholelithiasia), what happened to bilirubin?
increased conjugated bilirubin. --> Jaundice
(The liver converts ammonia to urea for excretion in the urine.)
2
