L25- Heme Catabolism and Jaundice (#7) Flashcards

1
Q

Roughly ___% of heme destined for degradation by resident macrophages comes from SENESCENT RBCs , and ____% from the turnover of IMMATURE blast cells (in the bone marrow). Where do the rest come from?

A

70%
15%

Cytochromes (liver and many other cells)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is free heme degraded by (although toxic and not recyclable)?

A

Heme oxygenase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What does heme oxygenase produce?

A

Biliverdin and releasing iron

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What converts biliverdin into bilirubin?

A

Biliverdin reductase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What type of enzyme is heme oxygenase?

A

Cytochrome P450 enzyme, phase 1 drug metab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the unconjugated bilirubine (UCB) made from? (reaction) What do these two reactions require?

A

Heme oxygenase produces biliverdin
Biliverdin reductase converts biliverdin into bilirubin which is called UCB

NADPH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Why is UCB very hydrophobic? What binding does it form to serum albumin for its transport?

A

Due to internal H-bonding

UCB forms non-covalent binding to serum albumin for its transport

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How is conjugated bilirubin formed during the step of uptake of UCB by the liver? What is this reaction catalyzed by?

A

Attachment of 2 glucornic acid residues

Catalyzed by liver UDP-glucuronyl transferase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

UCB is taken up itno the liver via what carrier?

A

OATP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

The addition of glucuronic acids to the bilirubin which forms CB during the uptake of UCB by liver does what?

A

Adding it makes CB hydrophilic so now it is amphipathic with both hydrophilic and hydrophobic characteristics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Clinical Note: Birds lack biliverdin reductase so in avian sepcies, biliverdin is the major pigment of ___

A

Bile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How is CB actively excreted into the bile?

A

Via an ATP-dependent carrier, MRP2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What happens to CB in healthy animals in relation to the blood? *

A

CB does NOT leak back into blood because presence of TIGHT JUNCTIONS*

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Clinical Note: Dubin- Johnson Syndrome is caused by a deficiency in _____ resulting in ______________

A

caused by MRP2 resulting in conjugated hyperbilirubinemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Clinical Note: Dubin-Johnson Syndrome is significant because there is no _______

A

Liver damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

During the step of formation of urobilinogen, the CB is metabolized by what?

A

Colonic bacteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Urobilinogen during its formation goes through what type of oxidation? What does it produce?

A

Non-enzymatic Auto-oxidation

producing sterocobilin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

The vast majority (>90%) of urobilinogen in the portal blood is ________________

A

Reabsorped by the liver and re-excreted into bile

19
Q

The process of reabsorbing urobiliongen in blood and re-excreting it into the bile without and chemical alteration is termed what?

A

Enterohepatic (re)circulation

20
Q

What happens to the small percentage of urobilinogen that is NOT taken up by the liver from the portal blood?

A

Enters systemic circulation and is filtered by the kidney

21
Q

To produce urine, urobilinogen goes through the non-enzymatic auto-oxiation, yielding what?

22
Q

Where is stercobilin found? Urobilin?

A

Stercobilin (found in the intestine)

Urobilin (found in the urine)

23
Q

Unconjugated bilirubin is ____ and ______ filtered at the kidney

A

Hydrophobic and IS NOT filtered at the kidney

24
Q

Conjugated bilirubin (if present) is _______ and ______ filtered at the kidney

A

Amphipathic and IS FILTERED at the kidney

25
What type of bilirubin would be present in a healthy organism? Unhealthy?
Healthy: Unconj bilirubin Unhealthy: Conj bilirubin
26
Clinical note: Jaundice is not a disease but a ____?
Sign of a disease
27
Clinical note: It is detectable when serum bilirubin exceeds______ mg/dL
2.0-3.0 mg/dL (hyperbilirubineamia)
28
In pre-hepatic jaundice due to hemolysis, what would serum tests say about IBIL (indirect bilirubin) [UCB] and why?
Increased | RBC lysis --> UCB --> Exceed the transport and conjugation capacity
29
In pre-hepatic jaundice due to hemolysis, what would serum tests say about DBIL(direct bilirubin) [CB]?
Normal | Although more bilirubin is being conjugated, the CB is being secreted to bile rather than blood
30
In pre-hepatic jaundice due to hemolysis, what would serum tests say about urinary urobilinogen?
Increase | This increase is due to an increase of prod of CB which is the precursor for urobilinogen
31
In pre-hepatic jaundice due to hemolysis, what would serum tests say about urinary bilirubin?
Normal | This test measures CB- since level of CB in the serum is normal, it is not present in the urine.
32
When UCB accumulates and is highly elevated, it does not get filtered out in the urine because of what?
Too hydrophobic
33
In pre-hepatic jaundice due to hemolysis, what would serum tests say about fecal urobilinogen?
Increased | The increase in urobilinogen is due to an increase in prod of CB which is coverted into urobilinogen
34
In hepatic jaundice due to hemolysis, what would serum tests say about IBIL (indirect bilirubin) [UCB] and why?
Normal to increased The increase is proportional to the extent of the liver cell dysfunction (Note: not a reliable predicator of jaundice)
35
In hepatic jaundice due to hemolysis, what would serum tests say about DBIL?
Increased A decrease transport of CB into the bile: depending on liver dysf severity, the transport of CB from hepatocyte may be reduced. The liver dmg results in leakage of CB in blood (Note: DBIL increase is sign of liver dmg)
36
In hepatic jaundice due to hemolysis, what would serum tests say about urinary urobilinogen?
Increased Liver is unable to reabsorb as much as urobilinogen as normal from the portal vein and more urobilinogen gets into the blood - Serum urobilinogen is amphipathic and is filtered at kidney into urine
37
In hepatic jaundice due to hemolysis, what would serum tests say about fecal urobilinogen?
Normal to decreased | Liver damage results in a decrease in rpod of conjugated bilirubin
38
In hepatic jaundice due to hemolysis, what would serum tests say about urinary bilirubin?
Increased Urinary bilirubin is increased, bc levels of the CB in blood is increased. CB is amphipathic and is readily filtered at the kidney
39
In post-hepatic jaundice due to hemolysis, what would serum tests say about IBIL (indirect bilirubin) [UCB] and why?
Normal to increased | If CB is increased, it is due to 2ndary liver damage- not a good indicator!
40
In oost-hepatic jaundice due to hemolysis, what would serum tests say about DBIL?
Increase | The increase in CB is ude to the backup of CB into the blood secondary to the bile blockage
41
In post-hepatic jaundice due to hemolysis, what would serum tests say about urinary urobilinogen?
Decreased The decrease in urobilinogen is due to a decrease in synthesis because of the blockage of bile duct- thus, CB is not able to enter intestine and to be catabolized into urobilinogen
42
In post-hepatic jaundice due to hemolysis, what would serum tests say about urinary bilirubin?
Increased | Bc levle of CB in blood in increased- CB is amphipathic and ready to be filtered at kidney
43
In post-hepatic jaundice due to hemolysis, what would serum tests say about fecalurobilinogen?
Decreased | The decrease in urobilinogen is due to blockage of the bile duct which prevents CB from entering intestine