An elderly homeless woman is brought to the hospital with yellowish color of her skin. From her somewhat incoherent story, it can be determined that she has consumed substantial amounts of alcohol over the past 3 decades. The physician made the diagnosis of alcoholic liver cirrhosis, associated with extensive liver fibrosis. Which of the following changes in plasma and urinary levels of bilirubin are most likely?

Question

Quizplus · Accepted Answer

Jaundice occurs from buildup of bilirubin metabolites, which are products of hemoglobin degradation. During degradation, first unconjugated bilirubin is generated, which is then taken up from the plasma by the liver. The liver conjugates bilirubin with glucuronic acid and releases it via bile into the GI tract. Excessive and long-term alcohol consumption damages hepatocytes and leads to increased total bilirubin, mostly conjugated, in plasma. Although the mechanism is not fully defined, the increase in conjugated plasma bilirubin might be due to release from damaged hepatocytes, reduced disposition within hepatocytes, and reduced secretion from hepatocytes. It is also possible that the liver damage resulted in obstruction of bile flow, which leads to a backup of largely conjugated bilirubin in the blood stream. Conjugated bilirubin is eventually removed by the kidneys and results in increased conjugated bilirubin in urine. Alcoholism might also lead to an increase in unconjugated plasma bilirubin, in the case that the ability of hepatocytes to remove unconjugated bilirubin from plasma is grossly impaired. As with all chronic diseases, alcoholism may present with a wide spectrum of symptoms.

An Elderly Homeless Woman Is Brought to the Hospital with Yellowish