Jaundice is a yellowish discoloration of body tissues

resulting from the deposition of bilirubin.

 Heme

heme oxygenase

biliverdin (green)

bilirubin (red-orange)
bile pigments

In Blood with albumin

UNCONJUGATED BILIRUBIN
(or INDIRECT BILITUBIN)
Excretion of bilirubin into
Uptake of Bilirubin
Conjugation of Bilirubin: by
bile:
hepatocytes:
In hepatocytes, bilirubin is
Conjugated bilirubin (bilirubin
conjugated with two molecules of
diglucuronide) is transported
Bilirubin dissociates
glucuronic into
from its
carrier
bile albumin & enters hepatocytes
canalculi
acid by the enzyme glucuronyl
& then into bile.
transferase
Process is energy dependent &
is impaired in liver diseases
 Conjugated bilirubin
bacteria
in the intestine
Urobilinogen

Stercobilin Reabsorbed
in stool
(brown)
Kidney

Urine Urobilin
(yellow)
Types of Jaundice

1- Hemolytic Jaundice
2- Hepatocellular Jaundice
3- Obstructive Jaundice
Blood:
Increased blood unconjugated (indirect) bilirubin

Urine:
Urobilinogen is increased
No bilirubin in urine (Color of urine is normal)
as it is bound to albumin

Stool:
Dark color
Increased stercobilin (produced from increased
urobilinogen)
Blood
Increased BOTH unconjugated (indirect) &
conjugated (direct) bilirubin
ALT & AST levels are markedly elevated

Urine:
Bilirubin is present in urine
So, urine color is yellowish brown

Stool
Pale (low stercobilin)
Blood:
Increased conjugated (direct) bilirubin
GGT & ALP are markedly elevated (ALT is normal or
mildly elevated)

Urine:
Bilirubin appears in urine
Thus, color is yellowish brown
Urobilinogen is reduced

Stool
Pale (low stercobilin)
LABORATORY INVESTIGATIONS IN TYPES OF JAUNDICE
URINE BLOOD
UNCONJUGATED CONJUGATED
UROBILINOGEN BILIRUBIN ALT & AST GGT & ALP
BILIRUBIN BILIRUBIN
NORMAL TRACE NIL N: 0.2 – 1 mg/dl N:0 - 0.2 mg/dl NORMAL NORMAL

HEMOLYTIC
INCREASD NIL INCREASED N:0 - 0.2 mg/dl NORMAL NORMAL
JAUNDICE

OBSTRUCT. Normal
MARKED
JAUNDICE Decreased or absent PRESENT N:0 - 0.2 mg/dl INCREASED or
INCREASE
mild increase

Normal
HEPATOCEL. Decreased or absent MARKED or
JAUNDICE PRESENT INCREASED INCREASED
INCREASED mild
increase