Bilirubin - Questions and Casuistry

Questions
1. Which type of bilirubin has a toxic effect on the basal ganglia?


 * A — conjugated (direct) bilirubin


 * B — unconjugated (indirect) bilirubin bound to albumin by van der Waals force
 * C — bilirubin that is covalently bound to albumin
 * D — free-of-bound bilirubin (does not bind to albumin)

2. Ligandin is a small protein enabling:
 * A — conjugation of bilirubin and glucuronic acid, first creating bilirubin glucuronide and then diglucuronide
 * B — transfer of bilirubin on the intracellular site into the smooth ER of a hepatocyte
 * C — transfer of conjugated bilirubin through the "bile pole" to the primary bile capillaries
 * D — a covalent bond between bilirubin molecule and albumin

1. Jaundice in an adult patient
A 42-year old man with severe icterus, abdominal pain localized in the upper right abdominal area, pale, fever, and shivers.

'''Lab. test results:'''


 * ALP = 8,4 μkat/l
 * cholesterol = 7,9 mmol/l (5-nukleotidáza – zvýšená hodnota)
 * AST = 0,64 μkat/l
 * total bilirubin = 421 μmol/l
 * prothrombin time: prolonged, physiological after intravenous application of vitamin K

Questions:


 * 1)  According to the clinical evidence given, what is probably the origin of jaundice (icterus) in the patient?
 * 2) Why is the prothrombin time prolonged?

2. Patient with jaundice and nausea
A patient has been admitted for an unintentional significant weight loss in a short period of time, severe nausea, vomiting, and later on developed jaundice and hepatomegaly

'''Lab. test results:'''


 * total bilirubin = 342 μmol/l
 * conjugated bilirubin = 171 μmol/l
 * ALP = 2,2 μkat/l
 * AST = 12,4 μkat/l
 * ALT = 11,2 μkat/l
 * albumin = 22 g/l
 * γ-globulin = 23,8 g/l (34 % of total proteins)

Questions:


 * 1)  According to the clinical evidence, what is probably the cause of his condition; are there any other examinations you would suggest for a better differential diagnosis?

Related Articles

 * Icterus
 * Hepatitis B
 * Differential Diagnosis of Icterus