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The Conjugated Hyperbilirubinemia Paradox
- Patients with liver dysfunction have conjugated hyperbilirubinemia.
- This is paradoxical, as conjugation is a liver function, yet it seems preserved in liver disease.
Conjugated Bilirubin in Liver Disease
- The fraction of conjugated bilirubin is typically low (3%) but increases in liver disease (20% in cirrhosis, 64% in viral hepatitis).
- Even in liver failure, conjugated bilirubin levels are significantly elevated.
Bilirubin Metabolism
- Unconjugated bilirubin is formed from hemoglobin breakdown in the spleen and is insoluble in water.
- It travels to the liver, where the enzyme UGT1A1 conjugates it with glucuronic acid, making it water-soluble.