me007
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68-y.o. pt has carcinoma of the head of pancreas
palpable gallbladder, total bilirubin is 10 mg/dL, unconjugated- 8.
What wll be found in urine?
Urine Bilirubin / Urine Urobilinogen
a 0 / 0
b 0 / +2
c +2 / 0
d +2 / +2
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| Ancylostoma
Forum Guru
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I'm a little confused, shouldnt it be conjugated 8
in that case my answer is C
Edited by Ancylostoma on 01/30/07 - 12:02 PM
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| me007
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god, now i'm cofused too.
source gives it as unconjugated. no wander that i messed with answer.
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| Ancylostoma
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I'm not an expert or a pathologist, but there is no way it could be unconjugated billirubin 8 with just carcinoma of the head of the pacreas and nothing else.
Basically bile obstruction that leads to the back up of conjugated billirubin , and thus billirubin in the urine. The conjugated billirubin is water soluble and can be excreted. Unconjugated is not and is carried on albumin.
uronobiliinogen is made in the gut with bacteria from secreted bile and reabsorbed and then secreted again. Some of it is excreted in the urine. If there is bile obstruction, there shouldnt be bile secreted and hence no urobillinoge in the urine.
anyway I think the q was a little wrong, they meant conjugated
If I'm wrong please correct me.
unconjugate bliilirubing increases in increase billirubin production, or problems in conjugation. there is no such condition in this case. Maybe that clears it up for you.
Edited by Ancylostoma on 01/30/07 - 12:11 PM
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| me007
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you are right.
tnx for clarifying
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| Clozapine
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I know both of u already know this .... but might be helpful for others (like me) for quick review
CB Fractionation/ Excretory index = CB/TB X 100 ( CB = conj. Bil; TB = Total Bil.)
In this q. if CB is 8 the CB Fractionation is (8/10) X 100 = 80
Urine Bilirubin /Urine Urobilinogen
Normal condition- Absent/ Trace
and when CB Fractionation <20%- Absent /+++
when CB Fractionation 20%-50%- ++ /++
when CB Fractionation >50% - +++ /Absent
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