Seum Bilirubin

Bilirubin is a yellow pigment that is created in the body during the normal recycling of old red blood cells. The liver helps break down bilirubin so that it can be removed from the body in the stool.

The liver produces bile which contains conjugated bilirubin. It is then sent to the gallbladder, and it has to be excreted properly from there. However, the gallstones are blocking the way, which makes it hard for the bilirubin to get out, and results in a build-up. This leads to jaundice, which occurs when one has and excessive amount of bilirubin.

With all living organisms, a process known as cell respiration is integral in order to provide the body with an essential form of energy, adenosine triphosphate (ATP). Oxygen, although an essential part of this process, can form reactants from colliding with electrons associated with carrier molecules. (pb101.rcsb.org, 2017). Hydrogen peroxide is an integral product of this reaction but is known to impose negative effects on the body if high levels are introduced. Explicitly, this reaction is caused “If oxygen runs into (one of these) carrier molecules, the electron may be accidentally transferred to it. This converts oxygen into dangerous compounds such as superoxide radicals and hydrogen peroxide, which can attack the delicate sulphur atoms and metal ions in proteins.” (pdbh101.rcb.org, 2017). Research has suggested that the hydrogen peroxide can be converted into hydroxyl radicals, known to mutate DNA, which can potentially cause bodily harm due to DNA’s role in the synthesis of proteins. These radicals can cause detrimental effects on the human body, and studies have suggested a link to ageing. Due to the harmful effects of these H2o2, it is important that the body finds a way to dispose of hydrogen peroxide before concentrations are too great.

She looked jaundiced (yellowing of her body tissues), which is due to accumulation of bilirubin, a blood product, due to impaired excretion by the liver (7). Her mental status was indicative of hepatic encephalopathy, with orientation to only person and place, and did not know the date or time. Abdominal examination exposed moderate tenderness, normal bowel sounds, and severe ascites. Ascites is an abnormal buildup of fluid in the abdominal cavity, and is often caused by blood backed up in the hepatic portal vein going into the liver, due to cirrhosis. The backed up blood fills with byproducts that cannot be processed by the diseased liver, which shuts down the kidneys. The disabled kidneys cause a buildup of fluid, which leaks out of the vasculature and into the abdominal cavity (8). Diseased livers also often produce less albumin, a protein in the blood that helps keep fluid in the vasculature. When the albumin levels drop, fluid leaves the blood, entering the body as edema, or swelling, which was moderately visible in her feet (9). Upon rectal examination, hemorrhoids were noted to be present, but are not considered a pathology, simply an anatomical structure that exists in most people from a young age (10). A stool sample was taken, and tested positive for blood with a hemoccult test.

As explained by Dr. Richard Weisiger, bilirubin is produced during the breakdown of Hgb and other hemoproteins, and it is filtered out by the liver. Hyperbilirubinemia occurs when the liver cannot filter the bilirubin from the blood fast enough and the bilirubin is absorbed into tissues causing jaundice.

On comparison between initial and repeated the liver function tests and the urea and electrolytes tests, the results are still deranged. The results for AST and ALT remained high at 1110 U/L and 2419 U/L. An increase in AST and ALT results can be due to a number of conditions, including fatty liver disease, alcoholic liver disease and trace metal disorders such as Wilson’s disease which can progress into acute liver failure. When looking at the elevated ratio of AST to ALT in these conditions it is possible to determine the origin and the extent of the damage depending on the raised level of each liver enzyme. In alcoholic liver disease, the AST activity is predominantly raised to a higher level than the ALT to a ratio of 2:1. In contrast, in the case of fatty liver disorders the enzyme activity ratio would be 2.2, given with a sensitivity of 94% and specificity of 86%

These superoxides may be dangerous because they alter the structure of iron and protein via reduction. They may also undergo dismutation to form hydrogen peroxide which, in turn, gives rise to hydroxyl radicals, the most reactive ROS (Gulumian and Van Wyk, 1987; Agarwal et al., 2005). Hydrogen peroxide is not a free radical but its neutral charge allows it to pass through cell membranes and so this makes it very dangerous (Kurutas, 2015). Other internal or endogenous sources for these free radicals are inflammation, xanthine oxidase, peroxisomes, phagocytosis, exercise and ischaemia. Exogenous factors which lead to the development of these ROS include smoking, ozone, environmental pollutants, radiation, pesticides and drugs (Lobo et al.,

Albumin is the most significant amount of protein in the plasma formation by the liver and is a useful indicator of liver function, because the half-life of the albumin in serum is much than (20 days), and the level of serum albumin is not a reliable indicator of protein synthesis in the liver in acute liver disease. The site of albumin synthesis is only in the liver. In the patients sever from liver cirrhosis and ascites usually have low serum level. The normal serum range (3.5g/dl - 4.5 g/dl).

The liver is the largest gland and second largest organ in the human body. It is also the only internal organ capable of regeneration following injury. Located in the abdominal cavity, this reddish brown organ is divided into lobes of different size and shape. The liver plays a critical role in metabolism, digestion, elimination, and detoxification, among other processes. This organ performs a surprisingly large number of functions that influence virtually all other body systems. This is why diseases of the liver can be so devastating. One class of chronic diseases affecting the liver is cirrhosis. (Kasper, 2008)

One example of a disease of elevated bilirubin levels in the body due to an error in the excretion of the molecule, is jaundice. Jaundice is a disease of the liver in which bilirubin conjugation is often impaired. There are a number of ways in which the liver can be impaired to disallow the elimination of bilirubin, including hemolytic anemia, in which red blood cell counts are decreased dramatically as a lot of red blood cells are broken down in a short period of time, Gilbert’s syndrome, in which the enzyme glucuronyltransferase, an enzyme that allows bilirubin to be water soluble and therefore removed from the body through the bile, has been reduced, [6] or inflammation of the bile ducts which may prevent the secretion of bile to the small intestine, therefore allowing a buildup of bilirubin to occur. [7]

Gilberts syndrome could be one of the diagnoses for patient L as it is caused by the incapability of the hepatocytes to take up bilirubin from the blood. This causes the level of unconjugated bilirubin level to accumulate whilst the conjugated bilirubin level remains within range. As a result, the total bilirubin level is increased. Another diagnosis was Crigler-Najjar Type I syndrome, which takes place when unconjugated bilirubin is retained by the body whilst conjugation is impaired. This causes an increase in the total bilirubin level, as shown by its parameter reading value

In addition to dietary supplements, another alternative treatment that has promising results is milk thistle, which can be taken orally in capsule or tablet form, or by intravenous infusion. Milk thistle is a plant, which has been used for many centuries, whose seeds and fruits are used to treat liver diseases and bile duct problems. Currently, milk thistle is being examined to make chemotherapy less harmful to the human body, as well as promote the slowing of the growth of cancer cells. It is also being examined in clinical trial with child leukemia patients. Milk thistle’s active ingredient is silymarin, which help to protect the liver from the harmful chemicals found in chemotherapy. It is currently being studied to determine whether it

Bilirubin or C33H36N4O6 is a brownish yellow part of bile. It is secreted by the liver as an end product of the breakdown process of hemoglobin (2). The amount of bilirubin produced is directly related to quantity of red blood cells destroyed, and as such, there is not a specific amount in the body at one time. In its normal role, it travels through the blood stream unconjugated, until it reaches the liver. There it combines with glucuronic acid and is concentrated. Much of that is transported to the gallbladder where it is further concentrated. From the liver and gallbladder it passes through the intestines. In the intestines bacteria reduces it into mesobilirubinogen and urobilinogen. Some of the urobilinogen is reabsorbed into the blood

Gilbert’s syndrome is an autosomal recessive disorder characterized intermittent jaundice. It is due to mutations in the promoter region of the gene coding the enzyme UDP-glucuronyl transferase. As a result Hepatic bilirubin UGT activity is consistently decreased to approximately 30% of normal in individuals with Gilbert syndrome. People with Gilbert’s Syndrome experience deepening of jaundice with vigorous exercise, dehydration, febrile illnesses, stress, alcohol consumption and fasting. Prognosis is excellent. Two provocative tests, energy deprivation (fasting test) and nicotinic acid administration, have been used to diagnose the condition. Within 48 hours of the start of a fast, there is usually a 2- to 3-fold rise in the

MOLECULAR BASIS OF HEPATOPROTECTIVE AND ANTIOXIDANT ACTIVITIES OF SELECTED MEDICINAL PLANTS FOLLOWING CCL4-INDUCED HEPATOCELLULAR DAMAGE IN MICE