Heme, Iron and Bilirubin Metabolism II Flashcards
positive coombs
ABO incompatability
increased indirect bilirubin
usually pre-hepatic
-hemolysis
increased direct bilirubin
post-hepatic
-obstruction
phototherapy
trans to cis bilirubin
-cis in your piss
kernicterus
neuro sx
-severe hyperbilirubinemia
free unconjugated bilirubin
can cross BBB - to kernicterus
pale stool
post-hepatic
gallstones
alcoholism
post-hepatic
abdominal radiograph or CT
sentinel loop
air filled LUQ of small intestine
seen on radiography for gallstones
mobilferrin
transport of Fe2+ in cytoplasm of cell - to basolateral membrane
hephaestin
ferroxidase
converts Fe2 to Fe3 for plasma carry - via transferrin
hepcidin
down regulates ferroportin
hemochromatosis
with loss of hepcidin
anemia of chronic disease
with increased hepcidin
UDPGT
converts unconjugated to conjugated bilirubin - in liver SER
adds glucuronide to the bilirubin
stercobilin
stool black pigment
urinary bilirubin
if there is increased serum conjugated bilirubin
intestinal bacteria
convert conjugated bilirubin to urobilinogen
that may be excreted or reabsorbed
normal serum bilirubin
0.2-1
<0.2 - conjugated
jaundice and icterus
elevated serum bilirubin
prehepatic
hemolysis
unconjugated bilirubin
gilberts
stressed college student gets jaundice
mutation - impaired hepatocellular uptake of unconjugated bilirubin
crigler najjar
enzyme mutation - defective conjugation of bilirubin
very high unconjugated
dubin johnson
black stool
defective secretion by hepatocyte of conjugated bilirubin
elevated direct and indirect
-total levels 5-10
post-hepatic
impaired excretion
-mechanical obstruction
clay colored stool - decreased urobilin/stercobilin in stool
increased conjugated bilirubin in serum
