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Old 05-14-2012
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Urine Sample Urobilinogen in Viral Hepatitis

HI!
BY THE GOLJAN RR URINE urobilinogen IN VIRAL HEPATITIS IS INCREASE BUT BY FA -DECREASE SO HOW YOU THINK WHICH ONE IS CORRECT ?
I THINK GOLJAN IS RIGHT
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whenever theres damage to the liver (hepatitis), isnt there increase in both conjugated and unconjugated bilirubin? they leak out from the damaged liver?

and since UCB is water-soluble, we will see it in the urine.

is that how it works?
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he is asking about urobilinogen. portion of urobilinogen is normally reabsorbed through gut , into portal circulation and into liver. When liver is damaged it cant take it up so it goes into systemic cirulation - and voiiila! next thing u know it ends up in ur urine
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Quote:
Originally Posted by Dr.NickRiviera View Post
whenever theres damage to the liver (hepatitis), isnt there increase in both conjugated and unconjugated bilirubin? they leak out from the damaged liver?

and since UCB is water-soluble, we will see it in the urine.

is that how it works?
well i think CB is water soluble and not UCB.......!!!!
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Quote:
Originally Posted by K06100 View Post
well i think CB is water soluble and not UCB.......!!!!
fcuk, yea it is
ok then i totally dont understand whats going on here

can somebody explain to me please?
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Quote:
Originally Posted by Dr.NickRiviera View Post
fcuk, yea it is
ok then i totally dont understand whats going on here

can somebody explain to me please?
Nick, read the thread I posted above... Didn't make sense to me either until that.
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Early on it increases lately decreases this makes more sense to me
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liver damage = less conjugated bilirubin = less CB -> urobilinogen conversion

so the answer should be decreased urobilinogen in urine, no?
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Quote:
Originally Posted by Dr.NickRiviera View Post
liver damage = less conjugated bilirubin = less CB -> urobilinogen conversion

so the answer should be decreased urobilinogen in urine, no?
It should be if 90% of absorbed UBG enters liver (which is what normally occurs)
But in hepatitis liver diverts absorbed UBG and all of that enters urine (instead of only 10% - in normal conditions)
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Originally Posted by MedicalExaminer View Post
It should be if 90% of absorbed UBG enters liver (which is what normally occurs)
But in hepatitis liver diverts absorbed UBG and all of that enters urine (instead of only 10% - in normal conditions)
what do you mean absorbed urobilinogen?
isnt urobilinogen something that comes from the conversion of conjugated bilirubin that has been secreted out of the liver?
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Quote:
Originally Posted by Dr.NickRiviera View Post
what do you mean absorbed urobilinogen?
isnt urobilinogen something that comes from the conversion of conjugated bilirubin that has been secreted out of the liver?
Yes thats it
Normaly liver gets 90% of absorbed UBG And kidneys only 10%
In hepatitis there is Less CB = less UBG
But When UBG is absorbed all of it (roughly 100%) enters the kidneys and non enters the liver
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Originally Posted by MedicalExaminer View Post
Yes thats it
Normaly liver gets 90% of absorbed UBG And kidneys only 10%
In hepatitis there is Less CB = less UBG
But When UBG is absorbed all of it (roughly 100%) enters the kidneys and non enters the liver

are you saying UCB into the liver becomes CB then into gut to become UBG and then 90% of that UBG goes back into the liver?
but since theres a problem with the liver it wont take it up and it gets redirected to the kidneys?

if thats the case, how is the UBG getting made in the first place? shouldnt the liver damage decreased CB so theres nothing to make UBG from (since CB -> UBG).
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I want to say that till there is no significant reduction in CB u will have high urinary UBG
But as disease advances and CB level falls to a certain low level there will be a reduction in UBG in total and consequently in urinary UBG
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Quote:
whenever theres damage to the liver (hepatitis), isnt there increase in both conjugated and unconjugated bilirubin? they leak out from the damaged liver?
Yes, because not every hepatocyte is damaged, so you still have a LOT of functional ones that will convert UCB to CB. But because the liver isn't functioning at its best it can't convert all the UCB to CB, and even the some of the CB it did manage to make won't be secreted as efficiently so both UCB and CB increase in blood.

The CB that does manage to get secreted and enters the intestines are converted to UBN, while most of it is lost in the feces as stercobilin, some of it is reabsorbed by the gut (ileum) and goes back to the liver (recycling). But since the liver isn't functioning normally a large portion of it won't be taken up by the liver and will spill into blood.

So over all you have in increase in UCB, CB and UBN in blood, the water soluble CB and UBN will pass into urine.

If the liver get's to the point where damage is so severe that barely any of the UCB is converted to CB, you'll have simply have increased UCB in blood with no corresponding increase in CB or UBN. But by this time the patients probably slipped into a coma or passed.
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Last edited by slowpoke; 05-15-2012 at 07:52 PM.
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Old 05-18-2012
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Yes, because not every hepatocyte is damaged, so you still have a LOT of functional ones that will convert UCB to CB. But because the liver isn't functioning at its best it can't convert all the UCB to CB, and even the some of the CB it did manage to make won't be secreted as efficiently so both UCB and CB increase in blood.

The CB that does manage to get secreted and enters the intestines are converted to UBN, while most of it is lost in the feces as stercobilin, some of it is reabsorbed by the gut (ileum) and goes back to the liver (recycling). But since the liver isn't functioning normally a large portion of it won't be taken up by the liver and will spill into blood.

So over all you have in increase in UCB, CB and UBN in blood, the water soluble CB and UBN will pass into urine.

If the liver get's to the point where damage is so severe that barely any of the UCB is converted to CB, you'll have simply have increased UCB in blood with no corresponding increase in CB or UBN. But by this time the patients probably slipped into a coma or passed.
ok i think i get it, thanks!
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Old 05-19-2012
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Originally Posted by Dr.NickRiviera View Post
ok i think i get it, thanks!
Hey.. im sorry im interrupting, but this topic kinda bothered me so i understand how it feels .. anyways.. In Viral hepatitis, You damage "TWO", things in perticular.. 1- Hepatocytes 2- Bile Ductules. Now.. if u damage ur Hepatocytes, you cant really conjugate bili much, so you get INC UCB in the blood.. but since it cant really go anywhere, it would keep on running in your blood till it ultimately gets conjugated, the story of UCB ends here. Once it does get Conjugated, it cant really leave the liver in bile as the small BILE DUCTULES are compromised, so CB will just get absorbed in the blood as is and gets secreted out as BILI (as its water soluble) in the urine (WHICH IS DARK CAUSE OF THIS BILI!). In order for you to get urobilinogen you have to get this CB in the duodenum so it can be later converted to urobilinogen by intestinal flora and exc out in urine, WHICH YOU CANT as the ducts are blocked, so a whole lot OF CB wont reach the DUOdenum in the first place for urobilinogen to be synthesized.. so DECREASED urobilinogen. For this explanation you have to understand the bile outflow disruption in viral hepatits alongwith the hepatocellular damage.

Hope this helps.

Last edited by saad_2k; 05-19-2012 at 01:45 AM.
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Quote:
Originally Posted by saad_2k View Post
Hey.. im sorry im interrupting, but this topic kinda bothered me so i understand how it feels .. anyways.. In Viral hepatitis, You damage "TWO", things in perticular.. 1- Hepatocytes 2- Bile Ductules. Now.. if u damage ur Hepatocytes, you cant really conjugate bili much, so you get INC UCB in the blood.. but since it cant really go anywhere, it would keep on running in your blood till it ultimately gets conjugated, the story of UCB ends here. Once it does get Conjugated, it cant really leave the liver in bile as the small BILE DUCTULES are compromised, so CB will just get absorbed in the blood as is and gets secreted out as BILI (as its water soluble) in the urine (WHICH IS DARK CAUSE OF THIS BILI!). In order for you to get urobilinogen you have to get this CB in the duodenum so it can be later converted to urobilinogen by intestinal flora and exc out in urine, WHICH YOU CANT as the ducts are blocked, so a whole lot OF CB wont reach the DUOdenum in the first place for urobilinogen to be synthesized.. so DECREASED urobilinogen. For this explanation you have to understand the bile outflow disruption in viral hepatits alongwith the hepatocellular damage.

Hope this helps.
uh oh, thats opposite what they were saying above lol
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uh oh, thats opposite what they were saying above lol
Haha hope the concept is clear now thanks.
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