OnlineMedEd Shared "Physiology of Bile and Bilirubin" - 8 Picmonics

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Physiology of Bile and Bilirubin

Bile
Synthesis and Circulation
Synthesized Continuously By Hepatocytes
Cholesterol 7 Alpha-Hydroxylase Rate Limiting Step
Stored In Gallbladder
Secreted Into Duodenum
Bile Salts Reabsorbed In Terminal Ileum
Returned To Liver Via Portal Circulation
Composition
Bilirubin
Bile Salts
Cholesterol And Phospholipids
Ions And Water
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4 mins
Bile Acid Resins
Indications
Hyperlipidemia
Mechanism of Action
Bile Acid Reabsorption Prevented
Slight Increase HDL/Triglycerides
Decrease LDL
Drugs
Colestipol (Colestid)
Cholestyramine
Colesevelam
Side Effects
Cholesterol Gallstones
Decreased Absorption of Fat-soluble Vitamins
Patients Hate It
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2 mins
GI Absorption
Stomach
Alcohol
Duodenum
Iron
Jejunum
Folate
Terminal Ileum
Vitamin B12
Bile Resorption
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1 min
Small Intestine Digestion
Brush border enzymes
Pancreatic Enzymes are secreted via a Duct
Pancreas secretes bicarbonate
Brush Border activates Pancreatic Trypsin
Trypsin activates Chymotrypsin
Trypsin and Chymotrypsin digest Proteins
Gallbladder Releases Bile
Pancreatic Lipase breaks down Lipids
Goblet cells secrete mucus
Pancreatic Amylase breaks down Carbohydrates
Pancreatic Nucleases breakdown DNA/RNA
Digestion occurs in the Duodenum
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2 mins
Hyperbilirubinemia
Cause/Mechanism
Increased Unconjugated Bilirubin
Assessment
Jaundice
Kernicterus
Interventions
Early Feedings
Heme Oxygenase Inhibitors
Phototherapy
Protect Eyes
Monitor for Dehydration
Considerations
Monitor Bilirubin Levels
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3 mins
Jaundice
General
Due To Elevated Conjugated Or Unconjugated Bilirubin
Unconjugated
Hemolysis
Crigler-Najjar Or Gilbert's Syndrome
Physiologic Jaundice Of Newborn
Conjugated
Biliary Obstruction From Stone Or Mass
Cholangitis
Dubin-Johnson And Rotor Syndrome
Mixed
Cirrhosis
Hepatitis
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5 mins
Bilirubin Lab Value
0.2-1.2 mg/dL
Increased Bilirubin Causes Jaundice
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54 secs
Crigler-Najjar Syndrome Type 1
Pathophysiology
Autosomal Recessive
Absent UDP-glucuronosyltransferase
Symptoms
Neonatal Jaundice
Kernicterus
Diagnosis
Normal Liver Function Tests
Elevated Unconjugated Bilirubin
Treatment
Phototherapy
Plasmapheresis
Calcium Phosphate and Orlistat
Death often by Age 2
Considerations
No Response to Phenobarbital
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3 mins

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