Question

1. What is indirect bilirubin?
2. What is direct bilirubin?
3. Explain what happens in conjugation of the bilirubin?
4. Why is urine yellow and stool brown?
5. Someone who is jaundice asks the nurse why their urine is so brown? What is the nurses response?
6. Why does someone with portal hypertension often have ascites?
7. What role does RAAS play in ascites?
8. What is the priority in the care of someone with ascites?
9. What medications may be used? Why?
10. What is the danger of removing too much fluid at one time in the abdomen during a paracentesis?
11. What happen to the liver that has cirrhosis? What causes the damage?
12. What are the most common causes of cirrhosis?
13. Why are people with liver failure (Cirrhosis) often anemic?
14. Why are people with liver failure (Cirrhosis) often thrombocytopenic?
15. Why are people with liver failure (Cirrhosis) often deficient in fat soluble vitamins

Why are people with liver failure (Cirrhosis) often at risk for bleeding

Answer 1

Ans) Indirect bilirubin is the difference between total and direct bilirubin. Common causes of higher indirect bilirubin include: Hemolytic anemia. This means your body is getting rid of too many red blood cells. . Bleeding in the lung caused by a blood clot.

- Bilirubin is a tetrapyrrole produced by the normal breakdown of heme. Most bilirubin is produced during the breakdown of hemoglobin and other hemoproteins. Accumulation of bilirubin or its conjugates in body tissues produces jaundice (ie, icterus), which is characterized by high plasma bilirubin levels and deposition of yellow bilirubin pigments in the skin, sclerae, mucous membranes, and other less visible tissues.

Because bilirubin is highly insoluble in water, it must be converted into a soluble conjugate before elimination from the body. In the liver, uridine diphosphate (UDP)-glucuronyl transferase converts bilirubin to a mixture of monoglucuronides and diglucuronides, referred to as conjugated bilirubin, which is then secreted into the bile by an ATP-dependent transporter. This process is highly efficient under normal conditions, so plasma unconjugated bilirubin concentrations remain low.

- In the liver, bilirubin is conjugated with glucuronic acid by the enzyme glucuronyltransferase, making it soluble in water: the conjugated version is the main form of bilirubin present in the "direct" bilirubin fraction. Much of it goes into the bile and thus out into the small intestine.

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