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    hunteradam07 is offline Permanently Banned 511 points
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    Question about bilirubin metabolism!

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    According to Goljan's notes, if conjungated Bilirubin (CB)<20% that mean unconj bilirubin (UCB) is increased. An increase in UCB can come from increase production-Hemolytic Amenia-decrease uptake or lack enzyme. But what i dont understand is if in his notes he says urine bilirubin is absent and increase in urine urobilinogen. This i dont understand. How come there is no increase in urine bilirubin? I am assumed urine bilirubin is same as CB. Can anyone help? Thanks

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    student-2 is offline Senior Member 510 points
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    Bilirubin metabolism is a long story- I would suggest googling it but just for the main scheme-
    Unconjugated bili is NOT water soluble and it's a byproduct of heme molecules. The liver, does what it does best and tries to make bili excretable by conjugating it (by all those mechanisms learned in biochem) thus making it water soluble. The fact that it's soluble means it can be secreted in urine (bili is what makes pipi yellow).
    Now the twist is the role the GI system plays in all of this because some of the bili is re-unconjugated by bacteria thus staying in the body etc etc.
    I will attach a foto and just follow the arrows and take time to understand it- it isn't so complex once you see it.
    I suggest if you have further questions make them more specific b/c it is impossible to explain like this all of bili metabolism.

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