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Bilirubin (part of cholestasis) - Coggle Diagram
Bilirubin (part of cholestasis)
bilirubinuria
def: bili in urine
weak func parameter
varia causes of inc, can be norm in liver dusfunc
dogs
low lvls of bili-uria norm
occurs BEFORE hyperbili-emia
always do a UA
cats
never norm to have bili in urine
DOES NOT INC W RENAL FAILURE
when capacity for renal excre is exceeded = hyperbili-emia
causes
hemolytic/pre-hepatic
hemolysis (RBC destruc) leads to inc bili produc w/in M0
extravasc
M0 in spleen inges RBC directly
intravasc
RBC are lysing w/in vasc space, M0 uptake free Hgb
travel to kidney = hgb-uria
hgb-emia
inc ubili = overwhelms liver's abil to process
liver cannot conju enough of it and builds up in the blood
ubili inc 1st bc liver can't conju it
cbili inc later bc liver tries to conju it
lab abnorm
RBC
regener anemia if enough time has passed for regener to occur
pre-regener anemia - if you are bleeding out and don't have an Fe defic
morph changes
spherocytes
extravasc hemolysis
schistocytes
intra or extravasc
ghost c
intravasc hemolysis
Heinz bodies
prone to lysis or inc removal from circ
agglut
indic IMHA
hyperbili-emia/uria
+/- hgb-emia/uria
enz
ALP
WRI or mild inc
inc secondary to hepatocellu bc hypoxic damage or endog steroid induc
dogs have stress induc elev
GGT
ALT, AST, SDH
may inc due to secondary hepatocellu hypoxia
cholestatic
hepatic/func
dec uptake or conju of bili by hepatocytes
liver is messed up
causes
sepsis, lepto, endotox
liver failure or dysfunc
anorexia in horses
post-hepatic/obstructive
inside and outside liver
unconju bili
released from M0
trnspt in blood to hepatocytes via alb
taken up by hepatocytes
convert unconju bili (ubili) to conju (cbili)
cbili trnspt to bile canaliculi against conc grandient
cbili excre as bile into intes
cbili converted to urobilinogen by bact
urobilinogen converted to stercobilinogen
2 more items...
reabsorbed in gut
2 more items...
see during cholestasis
conju bili = direct bili
origin
comes from RBC brkdn
M0 eat dying RBC in spleen, liver, BM
brk into
globin
aa
heme
iron
protoporphyrin
converted to biliverdin
unconju bili (indirect)
during cholestasis
bili inc
sm amt of cbili can escape back across hepatocyte
enters bloodstream (bs)
filtration at glom
excre in urine
cbili can bind to prot
too big for glom = delta bili
delta bili can be measured
most commonly looked at in horses
overall not very useful
inc when
during cholestasis
other
blood msmt
total bili
unconju = indirect
conju = direct
delta bili
not helpful in determ where bili is inc