Bilirubin

In jaundice, the sclerae, mucous membranes and skin are lemon-yellow in colour (Fig. 2.3B), A useful site to look for jaundice is the sublingual mucosa. Jaundice that may be obvious in daylight may he undetected in artificial light.

In haemolytic jaundice there is an increase in circulating unconjugated bilirubin, which is not excreted in the urine. The stools are dark and the urine looks normal but contains an excess of urobilinogen.

In hepatocellular and obstructive jaundice, bilirubin has been dissociated from plasma albumin and conjugated with glucuronic acid by the liver. Conjugated bilirubin is water soluble and readily passes through the renal 010111611111. The urine is brown like beer and the stools lend lo be pale in colour like putty, because of the reduction in the amount of bile in the faeces.

If jaundice is deep and long-standing, a distinct greenish colour develops in the sclerae and in the skin owing to the presence of bilivcrdin. Scratch marks may be prominent in obstructive jaundice: the precise cause of the associated pruritus is unknown but may be attributed to the retention of bile acids. The causes of hepatocellular and obstructive jaundice arc discussed 011 page 154.

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