Liver or hepatocyte transplants Cytochrome P450 inducers ◦ Phenobarbital Phototherapy ◦ Wavelengths of nm
Rate of secretion or flow of bile is obstructed Hepatitis or biliary obstructions ◦ Invasive treatments are preferred BILE
Fox, S. “Human Physiology.” 12e Kapitulnik, J. “Bilirubin: An Endogenous Product of Heme Degradation with Both Cytotoxic and Cytoprotective Properties.” Molecular Pharmacology Leach, T. “Bilirubin Metabolism and Jaundice.” AlmostADoctor metabolism-and-jaundice. Nazer, H. and J. Katz. “Unconjugated Hyperbilirubinemia.” Medscape Nelson, D.L., and M.M. Cox. “Principles of Biochemistry.” 5e Ophardt, C. “Hemoglobin Catabolism and Bilirubin.” Virtual Chembook Weisiger, R.A., and J. Katz. “Conjguated Hyperbilirubinemia.” Medscape Voet, D., J.G. Voet, and C.W. Pratt. “Fundamentals of Biochemistry: Life at the Molecular Level.” 4e
Bilirubin is a waste product formed from the catabolism of heme, using the enzymes heme oxygenase and biliverdin reductase. In the liver, unconjugated bilirubin which is insoluble in water is conjugated with glucuronic acid by the enzyme UGT to form the soluble (conjugated) bilirubin. Bilirubin is converted to microbial enzymes into urobilinogen and oxidized to stercobilin to be excreted in feces. Urobilinogen can also be reabsorbed from intestines and converted to urobilin to be excreted in urine Unconjugated hyperbilirubinemia is caused by increased production of bilirubin, impaired conjugation or impaired hepatic uptake Conjugated hyperbilirubinemia is caused by hepatic or biliary obstructions Gilbert's syndrome is the most common hereditary cause of hyperbilirubinemia, and is found in up to 5% of the population. It is caused by elevated levels of unconjugated bilirubin in the bloodstream as a result of reductions in glucuronyltransferase.